Healthcare Provider Details

I. General information

NPI: 1063661643
Provider Name (Legal Business Name): LINDA LEE HOVORKA A.A.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 HIGH GROVE BLVD
BURR RIDGE IL
60527-7585
US

IV. Provider business mailing address

9720 W 58TH STREET
COUNTRYSIDE IL
60525-4004
US

V. Phone/Fax

Practice location:
  • Phone: 630-920-2905
  • Fax:
Mailing address:
  • Phone: 708-712-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number160.001199
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: