Healthcare Provider Details

I. General information

NPI: 1124389374
Provider Name (Legal Business Name): STEVEN M PFAFF PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6933 N LINCOLN AVE
LINCOLNWOOD IL
60712-2605
US

IV. Provider business mailing address

205 W WACKER DR SUITE 1020
CHICAGO IL
60606-1216
US

V. Phone/Fax

Practice location:
  • Phone: 847-674-2294
  • Fax: 847-674-2397
Mailing address:
  • Phone: 312-640-0329
  • Fax: 312-640-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070019192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: