Provider Demographics
NPI:1114665080
Name:CARABALLO, AUBREY LYNNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:LYNNE
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6128 W BARRY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4029
Mailing Address - Country:US
Mailing Address - Phone:773-358-8091
Mailing Address - Fax:
Practice Address - Street 1:1601 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1233
Practice Address - Country:US
Practice Address - Phone:847-825-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.026531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist