Individual
AMETHYST DENEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
1201 RICKER RD, SALEM, IL 62881-4263
(618) 548-3194
Mailing address
545 WOMBLE RD, HARRISBURG, IL 62946-5457
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
008989
KY
225100000X
Physical Therapist
Primary
070028003
IL
225100000X
Physical Therapist
2305215820
VA
225100000X
Physical Therapist
P22182
NC
Other
Enumeration date
09/11/2023
Last updated
02/03/2024
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