Healthcare Provider Details

I. General information

NPI: 1770775793
Provider Name (Legal Business Name): ALLISON SCHACHT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 W MONTROSE AVE
CHICAGO IL
60641-1331
US

IV. Provider business mailing address

5545 W MONTROSE AVE
CHICAGO IL
60641-1331
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-6648
  • Fax: 773-282-6965
Mailing address:
  • Phone: 773-282-6648
  • Fax: 773-282-6965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: