Provider Demographics
NPI:1447475694
Name:KAVEESHWAR, AMEYA (PT)
Entity type:Individual
Prefix:
First Name:AMEYA
Middle Name:
Last Name:KAVEESHWAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W ONTARIO ST STE 240
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6957
Mailing Address - Country:US
Mailing Address - Phone:312-514-1478
Mailing Address - Fax:
Practice Address - Street 1:401 W ONTARIO ST STE 240
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6957
Practice Address - Country:US
Practice Address - Phone:312-514-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK21916Medicare UPIN
ILK21915Medicare UPIN