Provider Demographics
NPI:1174008338
Name:ADAME, CHARLENE (DPT)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:ADAME
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:GEETING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:1202 W. TAYLOR ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607
Practice Address - Country:US
Practice Address - Phone:312-471-8155
Practice Address - Fax:312-471-8156
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist