Amy Waterwall, MPT, CEAS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070013356 Issued in IL

Practice address

4700 Gilbert Ave
Suite 51
Western Springs, IL 60558-1753

Phone

(708) 387-1737

NPI assigned

Sep 22, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elmhurst Orthopaedics, SC

  • Orthopaedic Surgery Physician
  • Elmhurst, IL
  • NPI 1598716474
  NPD (past)
• Occusport Services Inc.

  • Physical Therapist
  • Lockport, IL
  • NPI 1952350886
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417651200000",
    "number": "1124128053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 GILBERT AVE",
            "address_2": "SUITE 51",
            "city": "WESTERN SPRINGS",
            "state": "IL",
            "postal_code": "605581753",
            "telephone_number": "708-387-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERWALL",
        "first_name": "AMY",
        "credential": "MPT, CEAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2014-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070013356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1636250",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreena
• Regina P Walker, MD
• Marissa Walsh
• Trairud-Jack Watanachaiyot, D.P.T.
• Ellen Welter, P.T.
• Western Springs Asthma & Allergy SC
• Western Springs Diagnostic Osteoporosis Center, LLC
• Western Springs Family Practice Center, LTD.
• Lawrence Michael Wieczorek, LCSW

• Physical Therapist in Western Springs, IL
• Providers in Western Springs, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.