Healthcare Provider Details

I. General information

NPI: 1205309432
Provider Name (Legal Business Name): MELISSA HEKR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 W JEFFERSON ST UNIT V
SHOREWOOD IL
60404-7301
US

IV. Provider business mailing address

1216 CHARTWELL TRCE
SHOREWOOD IL
60404-0534
US

V. Phone/Fax

Practice location:
  • Phone: 815-714-2977
  • Fax: 815-714-2139
Mailing address:
  • Phone: 815-301-7068
  • Fax: 815-714-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070024060
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: