Active NPI
Amanda N Walstrom, PT
- Physical Therapist
- Elburn, IL
National Provider Identifier
1447544226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070017338
- Practice address
- 623 Independence Ave
Elburn, IL 60119-9470 - Phone
- (630) 251-4498
- NPI assigned
- Jun 8, 2011
- Last updated
- Jun 8, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070017338 | IL | Primary |
| Physical Therapist | 225100000X | PTL-9552 | CO |
Addresses
Primary practice location
623 Independence Ave
Elburn, IL 60119-9470
Mailing address
623 Independence Ave
Elburn, IL 60119-9470
Phone (630) 251-4498
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTL-9552 | CO | MD | Physical Therapist |
| 070017338 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307491200000",
"number": "1447544226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "623 INDEPENDENCE AVE",
"city": "ELBURN",
"state": "IL",
"postal_code": "601199470",
"telephone_number": "630-251-4498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "623 INDEPENDENCE AVE",
"city": "ELBURN",
"state": "IL",
"postal_code": "601199470",
"telephone_number": "630-251-4498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALSTROM",
"first_name": "AMANDA",
"middle_name": "N",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-08",
"last_updated": "2011-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070017338",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "PTL-9552",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elburn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.