| Doctor Name: | MRS. AMY LYNN KOUDELKA |
| NPI Number: | 1215101191 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 070010691 |
| Business Practice Address: | 1300 N Market St Sparta, IL - 622861048 |
| Business Phone Number: | 6184432177 |
| Business Fax Number: | 6184434731 |
| Mailing Address: | 818 E Broadway St, Po Box 297 SPARTA |
| State: | IL |
| Postal Code: | 622861820 |
| Phone Number: | 6184432177 |
| Fax Number: | 6184431383 |
| NPI Enumeration Date: | 04/22/2008 |
| NPI Last Update Date: | 07/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070010691 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |