Healthcare Provider Details

I. General information

NPI: 1558471847
Provider Name (Legal Business Name): ZIBUTE PRANCKEVICIUS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6775 PROSPERI DR
TINLEY PARK IL
60477-4789
US

IV. Provider business mailing address

1284 CAMELOT LN
LEMONT IL
60439-8505
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-1260
  • Fax: 708-429-6622
Mailing address:
  • Phone: 630-917-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: