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General NPI Number Information
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NPI Number | 1538203880
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Entity Type | Individual
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Provider Name | EVETTE SOUHLAS COLL PT
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE BOX 142
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 773-327-2880
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Fax | 773-327-0547
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Provider Business Mailing Address
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Address Line | 4N050 FERSON CREEK RD
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City | ST CHARLES
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State | IL
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Zip | 60174-1131
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Country | US
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Telephone | 773-405-6020
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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 | 070012817
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License Number State | IL
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