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Individual

AMANDA N WALSTROM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
623 INDEPENDENCE AVE, ELBURN, IL 60119-9470
(630) 251-4498
Mailing address
623 INDEPENDENCE AVE, ELBURN, IL 60119-9470
(630) 251-4498

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070017338
IL
225100000X
Physical Therapist
PTL-9552
CO

Other

Enumeration date
06/08/2011
Last updated
06/08/2011
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