=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215267323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TENNESEE IRIS RAMOS CARAYO PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2010
-----------------------------------------------------
Last Update Date | 01/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10700 W HIGGINS RD STE 120
-----------------------------------------------------
City | ROSEMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-299-2801
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4945 N NAGLE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60630-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-513-9822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070.017355
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------