=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023833928
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAWSAN BELBACHIR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2024
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4934 MAIN ST
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515-3611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-964-4008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10504 S HIGHLAND AVE
-----------------------------------------------------
City | WORTH
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60482-1367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 160.010318
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------