Healthcare Provider Details

I. General information

NPI: 1659065423
Provider Name (Legal Business Name): LENA PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 MISSION HILLS RD APT 212
NORTHBROOK IL
60062-5743
US

IV. Provider business mailing address

1740 MISSION HILLS RD APT 212
NORTHBROOK IL
60062-5743
US

V. Phone/Fax

Practice location:
  • Phone: 773-742-1148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: