Healthcare Provider Details

I. General information

NPI: 1801328208
Provider Name (Legal Business Name): MARGARETH ENRIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W HINTZ RD
WHEELING IL
60090-5501
US

IV. Provider business mailing address

370 FLORIAN DR
DES PLAINES IL
60016-6052
US

V. Phone/Fax

Practice location:
  • Phone: 847-537-7474
  • Fax:
Mailing address:
  • Phone: 847-910-5417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.019573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: