Provider Demographics
NPI:1164553301
Name:CROSS, ARMENTHA L (056002718)
Entity Type:Individual
Prefix:MS
First Name:ARMENTHA
Middle Name:L
Last Name:CROSS
Suffix:
Gender:F
Credentials:056002718
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 LUELLA AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-1897
Mailing Address - Country:US
Mailing Address - Phone:312-296-7478
Mailing Address - Fax:773-373-7304
Practice Address - Street 1:336 LUELLA AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-1897
Practice Address - Country:US
Practice Address - Phone:312-296-7478
Practice Address - Fax:773-373-7304
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2012-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.002718225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1164153301OtherAPEX THERAPEUTIC SERVICES
IL1164553301OtherICG REHAB SERVICES, 1620 N. LASALLE, CHICAGO, ILLINOIS 60614