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Individual
AMY WATERWALL
Active
Individual
AMY WATERWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT, CEAS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070013356
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1636250
BCBS
IL
Enumeration date
09/22/2006
Last updated
12/04/2014
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