Provider Demographics
NPI:1851853006
Name:LONGSWORTH, AMELIA SHARMAINE
Entity Type:Individual
Prefix:
First Name:AMELIA SHARMAINE
Middle Name:
Last Name:LONGSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 W GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2116
Mailing Address - Country:US
Mailing Address - Phone:773-707-8910
Mailing Address - Fax:
Practice Address - Street 1:813 WASHINGTON ST APT 1N
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2261
Practice Address - Country:US
Practice Address - Phone:773-707-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist