Provider Demographics
NPI:1902000359
Name:ZANESKE, AMANDA SUE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:ZANESKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUE
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:15201 N HOLLY RD
Practice Address - Street 2:UNIT B
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1194
Practice Address - Country:US
Practice Address - Phone:248-531-0002
Practice Address - Fax:248-634-0679
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist