Provider Demographics
NPI:1649254624
Name:GUILLAUME, AMY (DPT, CSCS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GUILLAUME
Suffix:
Gender:F
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:MISCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7300 E INDIANA ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2794
Mailing Address - Country:US
Mailing Address - Phone:812-476-0409
Mailing Address - Fax:812-476-1016
Practice Address - Street 1:7300 E INDIANA ST
Practice Address - Street 2:STE. 102
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2794
Practice Address - Country:US
Practice Address - Phone:812-476-0409
Practice Address - Fax:812-476-1016
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007424A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000302853OtherBLUE CROSS BLUE SHIELD
IN200839680Medicaid
INP00364399Medicare UPIN
IN255480XMedicare PIN
IN000000302853OtherBLUE CROSS BLUE SHIELD