Individual
AMY WATERWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT, CEAS
Contact information
Practice address
4700 GILBERT AVE, SUITE 51, WESTERN SPRINGS, IL 60558-1753
(708) 387-1737
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
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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