Facts
- Status
- A
- Credential
- PT, DPT
- Type
- Individual
- Enumeration date
- 2014-08-24
- Last updated
- 2018-10-26
Specialties
Licenses
- License IL
- 070020862
Location
- Practice location
- 914 GREEN BAY RD STE 202
- City
- WINNETKA IL
- Postal code
- 600931701
- Phone
- 877-709-1090
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.