Healthcare Provider Details

I. General information

NPI: 1730186248
Provider Name (Legal Business Name): DEANA HERRMAN & PATRICE LASSA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 S WABASH AVE STE 208
CHICAGO IL
60605-2188
US

IV. Provider business mailing address

819 S WABASH AVE STE 208
CHICAGO IL
60605-2188
US

V. Phone/Fax

Practice location:
  • Phone: 312-386-9028
  • Fax:
Mailing address:
  • Phone: 312-386-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name: PATRICE LASSA
Title or Position: PRESIDENT
Credential: PTA
Phone: 312-386-9028