Provider Demographics
NPI:1104932201
Name:VAN SANTEN, AMY (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:VAN SANTEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ROCKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1209
Mailing Address - Country:US
Mailing Address - Phone:708-488-8744
Mailing Address - Fax:708-488-8744
Practice Address - Street 1:215 ROCKFORD AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1209
Practice Address - Country:US
Practice Address - Phone:708-488-8744
Practice Address - Fax:708-488-8744
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics