Provider Demographics
NPI:1841349487
Name:SCHAFFER, AMANDA KL (PT, MSPT, CSCS OCS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KL
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:PT, MSPT, CSCS OCS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KL
Other - Last Name:SCHAFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:704 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-9122
Mailing Address - Country:US
Mailing Address - Phone:815-505-1585
Mailing Address - Fax:
Practice Address - Street 1:704 STEWART AVE
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-9122
Practice Address - Country:US
Practice Address - Phone:815-505-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204585004Medicare PIN
IL204585004Medicare PIN