Provider Demographics
NPI:1952056731
Name:HALLENIUS, AMY KATHRYN (PTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHRYN
Last Name:HALLENIUS
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 1:818 N CALUMET RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1506
Mailing Address - Country:US
Mailing Address - Phone:630-352-6550
Mailing Address - Fax:
Practice Address - Street 1:700 DICKINSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3540
Practice Address - Country:US
Practice Address - Phone:219-983-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant