Healthcare Provider Details

I. General information

NPI: 1740301365
Provider Name (Legal Business Name): PAULINE BARRY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULINE TERADA DPT

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S MORGAN ST
CHICAGO IL
60607-3668
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 312-421-7274
  • Fax: 312-421-7289
Mailing address:
  • Phone: 630-575-1981
  • Fax: 630-928-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015675
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: