Healthcare Provider Details

I. General information

NPI: 1740683804
Provider Name (Legal Business Name): ANNALYN CUARTEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6170 JOLIET RD LAGRANGE MEDICAL CENTER
COUNTRYSIDE IL
60525-3976
US

IV. Provider business mailing address

150 HARVESTER DR SUITE 105
BURR RIDGE IL
60527-5919
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-0330
  • Fax: 708-352-8905
Mailing address:
  • Phone: 630-246-5100
  • Fax: 630-246-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070020651
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: