Healthcare Provider Details

I. General information

NPI: 1659954360
Provider Name (Legal Business Name): ISABELLA BADALAMENT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST STE 220
CHICAGO IL
60611-4741
US

IV. Provider business mailing address

1 E ERIE ST STE 220
CHICAGO IL
60611-4741
US

V. Phone/Fax

Practice location:
  • Phone: 773-525-5200
  • Fax: 773-525-5276
Mailing address:
  • Phone: 773-525-5200
  • Fax: 773-525-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number070.025819
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.025819
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: