Healthcare Provider Details

I. General information

NPI: 1215267323
Provider Name (Legal Business Name): TENNESEE IRIS RAMOS CARAYO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 W HIGGINS RD STE 120
ROSEMONT IL
60018-3714
US

IV. Provider business mailing address

4945 N NAGLE AVE
CHICAGO IL
60630-2927
US

V. Phone/Fax

Practice location:
  • Phone: 847-299-2801
  • Fax:
Mailing address:
  • Phone: 702-513-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.017355
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: