1942531777 NPI number — AMY PEKARSKY NEVILLE AMY NEVILLE, PT

Table of content: AMY PEKARSKY NEVILLE AMY NEVILLE, PT (NPI 1942531777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942531777 NPI number — AMY PEKARSKY NEVILLE AMY NEVILLE, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEVILLE
Provider First Name:
AMY
Provider Middle Name:
PEKARSKY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AMY NEVILLE, PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942531777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 REMINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-2223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 ISLAND PARK DR
Provider Second Line Business Practice Location Address:
STE 105B
Provider Business Practice Location Address City Name:
DANIEL ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29492-7559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-284-5285
Provider Business Practice Location Address Fax Number:
843-593-9396
Provider Enumeration Date:
01/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3439 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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