MEDICARE: DEANA HERRMAN & PATRICE LASSA, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant		IL
2	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1730186248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEANA HERRMAN & PATRICE LASSA, PC

Provider Business Mailing Address
First Line	:	819 S WABASH AVE
Second Line	:	STE 208
City	:	CHICAGO
State	:	IL
Zip	:	60605-2188
Country	:	US
Telephone Number	:	312-386-9028
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 S WABASH AVE
Second Line	:	STE 208
City	:	CHICAGO
State	:	IL
Zip	:	60605-2188
Country	:	US
Telephone Number	:	312-386-9028
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICE LASSA
Credential	:	PTA
Telephone Number	:	312-386-9028

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/12/2007

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