Provider Demographics
NPI:1942585120
Name:GENTILE, AMANDA M (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:GENTILE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:DAUS
Other - Suffix:
Other - Last Name Type:Former Name
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 1:999 E TOUHY AVE STE 450
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2748
Practice Address - Country:US
Practice Address - Phone:630-920-2323
Practice Address - Fax:630-232-5625
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-018805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01040909OtherMEDICARE RAILROAD
ILP01040909OtherMEDICARE RAILROAD