Provider Demographics
NPI:1740680479
Name:DEMITRY, AMIRA (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMIRA
Middle Name:
Last Name:DEMITRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 HOMESTEAD RD
Mailing Address - Street 2:APT 3
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-2158
Mailing Address - Country:US
Mailing Address - Phone:850-319-6630
Mailing Address - Fax:
Practice Address - Street 1:10233 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2518
Practice Address - Country:US
Practice Address - Phone:708-938-5238
Practice Address - Fax:708-938-5239
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist