Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 11629-24 | WI |
Y | 225100000X | Physical Therapist | PT014384 | OH |
N | 2251S0007X | Physical Therapist - Sports | 4411 | IA |
NPI | 1437387867 |
---|---|
Provider Name | Amanda Claire Krey |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Hilliard, OH 43026-9231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 03/10/2014 |