Provider Demographics
NPI:1184382699
Name:FORBES, AIMEE LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:LYNN
Last Name:FORBES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1906
Mailing Address - Country:US
Mailing Address - Phone:217-827-6159
Mailing Address - Fax:
Practice Address - Street 1:4101 W ISLES AVENUE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62712
Practice Address - Country:US
Practice Address - Phone:217-793-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004670225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant