Provider Demographics
NPI:1063021731
Name:PENA, AIMEE JANE ALEDIA (RPT)
Entity Type:Individual
Prefix:
First Name:AIMEE JANE
Middle Name:ALEDIA
Last Name:PENA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9335 LINDER AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1135
Mailing Address - Country:US
Mailing Address - Phone:224-623-2940
Mailing Address - Fax:
Practice Address - Street 1:500 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2724
Practice Address - Country:US
Practice Address - Phone:847-316-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist