Provider Demographics
NPI:1942216833
Name:WEBER, AMY L (MPT)
Entity Type:Individual
Prefix:MR
First Name:AMY
Middle Name:L
Last Name:WEBER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 W MARTIN AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6535
Mailing Address - Country:US
Mailing Address - Phone:630-355-3774
Mailing Address - Fax:630-355-4953
Practice Address - Street 1:10 W MARTIN AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6535
Practice Address - Country:US
Practice Address - Phone:630-355-3774
Practice Address - Fax:630-355-4953
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK16786Medicare PIN