Healthcare Provider Details

I. General information

NPI: 1326594532
Provider Name (Legal Business Name): CARA BONICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 W FOSTER AVE
CHICAGO IL
60640-1491
US

IV. Provider business mailing address

634 ACADEMY DRIVE
NORTHBROOK IL
60062
US

V. Phone/Fax

Practice location:
  • Phone: 773-433-1800
  • Fax:
Mailing address:
  • Phone: 410-667-7200
  • Fax: 888-502-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.007608
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: