Healthcare Provider Details

I. General information

NPI: 1497048458
Provider Name (Legal Business Name): EILEEN FRANCES HUFFMAN MS, PT, DPT, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN FRANCES RUNTZ MS, PT, DPT, CLT

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 WESLEY AVE
OAK PARK IL
60304-1319
US

IV. Provider business mailing address

813 WESLEY AVE
OAK PARK IL
60304-1319
US

V. Phone/Fax

Practice location:
  • Phone: 773-230-2672
  • Fax:
Mailing address:
  • Phone: 773-230-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070013488
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: