Healthcare Provider Details

I. General information

NPI: 1669753737
Provider Name (Legal Business Name): ALLISON MARIE HILDEBRAND PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BUTTERFIELD TRAIL
KANKAKEE IL
60901
US

IV. Provider business mailing address

4560 SE INTERNATIONAL WAY STE. 100
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 815-936-6500
  • Fax: 971-206-5203
Mailing address:
  • Phone: 971-206-5200
  • Fax: 971-206-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160005724
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: