Basic Information
| Provider Information | |||||||||
| NPI: | 1154595296 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BAK | ||||||||
| FirstName: | BEATA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15131 W 143RD ST | ||||||||
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| City: | HOMER GLEN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604918543 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3703 W LAKE AVE | ||||||||
| Address2: | SUITE200 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600265823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479981188 | ||||||||
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| ProviderEnumerationDate: | 04/19/2008 | ||||||||
| LastUpdateDate: | 04/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.