Healthcare Provider Details

I. General information

NPI: 1699044602
Provider Name (Legal Business Name): CAROL NAVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 E 71ST ST
CHICAGO IL
60649-2612
US

IV. Provider business mailing address

13222 S EXCHANGE AVE
CHICAGO IL
60633-1803
US

V. Phone/Fax

Practice location:
  • Phone: 773-721-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160005125
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: