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General NPI Number Information
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NPI Number | 1639245301
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Entity Type | Individual
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Provider Name | SUZANNE ACERON BADILLO P.T.
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 528 KEDZIE ST
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City | EVANSTON
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State | IL
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Zip | 60202-2306
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Country | US
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Telephone | 773-791-5969
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Fax | 773-791-5969
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Provider Business Mailing Address
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Address Line | 1201 HULL TER # 2
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City | EVANSTON
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State | IL
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Zip | 60202-3201
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Country | US
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Telephone | 773-791-5969
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Fax | 847-905-0218
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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 | 070011033
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License Number State | IL
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