Provider Demographics
NPI:1942531777
Name:NEVILLE, AMY PEKARSKY (AMY NEVILLE, PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:PEKARSKY
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:AMY NEVILLE, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:900 ISLAND PARK DR
Practice Address - Street 2:STE 105B
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7559
Practice Address - Country:US
Practice Address - Phone:843-284-5285
Practice Address - Fax:843-593-9396
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist