Provider Demographics
NPI:1346241866
Name:BHATTI, AMJAD A (DPT)
Entity type:Individual
Prefix:DR
First Name:AMJAD
Middle Name:A
Last Name:BHATTI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S BLOOMINGDALE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2952
Mailing Address - Country:US
Mailing Address - Phone:630-295-8988
Mailing Address - Fax:630-295-8989
Practice Address - Street 1:125 S BLOOMINGDALE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2952
Practice Address - Country:US
Practice Address - Phone:630-295-8988
Practice Address - Fax:630-295-8989
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2009-10-20
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
IL070-007139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02220205OtherBCBS PROVIDER NUMBER
IL02220205OtherBCBS PROVIDER NUMBER
IL02220205OtherBCBS PROVIDER NUMBER