Provider Demographics
NPI:1053347583
Name:DOSSETT, AMY LYNN (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:DOSSETT
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 1:122 SAINT SABRE DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1071
Mailing Address - Country:US
Mailing Address - Phone:618-540-9248
Mailing Address - Fax:618-624-7086
Practice Address - Street 1:1901 FRANK SCOTT PKWY E
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7342
Practice Address - Country:US
Practice Address - Phone:618-624-7077
Practice Address - Fax:618-624-7086
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist