Healthcare Provider Details

I. General information

NPI: 1942544754
Provider Name (Legal Business Name): MARIA ANALITIS PTA/FC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 FOUR LAKES AVE APT 4B
LISLE IL
60532-2918
US

IV. Provider business mailing address

1833 FOUR LAKES AVE APT 4B
LISLE IL
60532-2918
US

V. Phone/Fax

Practice location:
  • Phone: 708-567-7210
  • Fax:
Mailing address:
  • Phone: 708-567-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.003729
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: