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General NPI Number Information
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NPI Number | 1902962053
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Entity Type | Individual
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Provider Name | MARIJO WESTERHOFF LPTA
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Gender | Female
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Dates
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Enumeration Date | 12/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9735 SOUTHWEST HWY
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City | OAK LAWN
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State | IL
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Zip | 60453-3614
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Country | US
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Telephone | 708-424-7920
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Fax | 708-424-4597
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Provider Business Mailing Address
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Address Line | 15209 LAS ROBLES ST
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City | OAK FOREST
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State | IL
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Zip | 60452-1713
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Country | US
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Telephone | 708-535-6730
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Fax | 708-535-6730
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State | IL
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