Provider Demographics
NPI:1063680874
Name:WIESMAN, YAFA C (DPT)
Entity Type:Individual
Prefix:
First Name:YAFA
Middle Name:C
Last Name:WIESMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-5113
Mailing Address - Country:US
Mailing Address - Phone:773-878-6233
Mailing Address - Fax:773-878-2688
Practice Address - Street 1:5616 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-5113
Practice Address - Country:US
Practice Address - Phone:773-878-6233
Practice Address - Fax:773-878-2688
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic