Healthcare Provider Details

I. General information

NPI: 1023331790
Provider Name (Legal Business Name): MIRIAM BOELEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PFINGSTEN RD PHYSICAL THERAPY
GLENVIEW IL
60026-1301
US

IV. Provider business mailing address

2100 PFINGSTEN RD PHYSICAL THERAPY
GLENVIEW IL
60026-1301
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-5678
  • Fax: 847-657-5742
Mailing address:
  • Phone: 847-657-5678
  • Fax: 847-657-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number070002790
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: