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General NPI Number Information
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NPI Number | 1063392298
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Entity Type | Individual
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Provider Name | AVARY LAUREN BIELEMA DPT
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Gender | Female
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 1103 S STATE ST STE 300
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City | CHICAGO
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State | IL
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Zip | 60605-2775
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Country | US
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Telephone | 312-877-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 504 MEADOW LN
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City | MORRISON
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State | IL
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Zip | 61270-3054
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Country | US
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Telephone | 815-499-8718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070029481
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License Number State | IL
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