Individual
MRS. AMY LYNN KOUDELKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 N MARKET ST, SPARTA, IL 62286-1048
(618) 443-2177
(618) 443-4731
Mailing address
818 E BROADWAY ST, PO BOX 297, SPARTA, IL 62286-1820
(618) 443-2177
(618) 443-1383
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070010691
IL
Other
Enumeration date
04/22/2008
Last updated
07/05/2012
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