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General NPI Number Information
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NPI Number | 1407397854
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Entity Type | Individual
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Provider Name | OLGA BACLAY PT
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Gender | Female
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Dates
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Enumeration Date | 03/18/2017
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 1010 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-1522
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Country | US
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Telephone | 773-298-1573
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Fax |
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Provider Business Mailing Address
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Address Line | 8834 W 140TH ST UNIT 3B
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City | ORLAND PARK
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State | IL
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Zip | 60462-2214
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Country | US
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Telephone |
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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 | 070021066
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License Number State | IL
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