Basic Information
| Provider Information | |||||||||
| NPI: | 1548616436 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CELIS | ||||||||
| FirstName: | MARTHE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1240 SAINT JAMES PL APT 2F | ||||||||
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| City: | GLEN ELLYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601377805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3703 W LAKE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600261266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479981188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2016 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 160007305 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.