Healthcare Provider Details

I. General information

NPI: 1790163533
Provider Name (Legal Business Name): MICHELE M ALBERTS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE M BERNIER

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 JOLIET RD
COUNTRYSIDE IL
60525-4682
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-0547
  • Fax: 708-352-1535
Mailing address:
  • Phone: 630-575-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070005004
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: