Individual
AMANDA WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1644 E 53RD ST, CHICAGO, IL 60615-4210
(773) 214-6450
(773) 241-6501
Mailing address
1644 E 53RD ST, CHICAGO, IL 60615-4210
(773) 214-6450
(773) 241-6501
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070018004
IL
Other
Enumeration date
10/21/2010
Last updated
10/22/2010
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