Provider Demographics
NPI:1174635809
Name:OSTROFF, AUDREY BUNTING (PT)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:BUNTING
Last Name:OSTROFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 N MAUD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4906
Mailing Address - Country:US
Mailing Address - Phone:773-404-7696
Mailing Address - Fax:773-202-1410
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5713
Practice Address - Country:US
Practice Address - Phone:773-202-1616
Practice Address - Fax:773-202-1410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist