Provider Demographics
NPI:1669619003
Name:KING, AMIE L (PT)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:L
Other - Last Name:DOSMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:155 N BERTEAU AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2926
Mailing Address - Country:US
Mailing Address - Phone:773-896-8178
Mailing Address - Fax:
Practice Address - Street 1:183 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-6000
Practice Address - Country:US
Practice Address - Phone:630-832-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.011675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist