Provider Demographics
NPI:1174645295
Name:VENDRELY, ANN M (PT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:VENDRELY
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 1:211 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1676
Mailing Address - Country:US
Mailing Address - Phone:708-709-6535
Mailing Address - Fax:708-709-6252
Practice Address - Street 1:211 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1676
Practice Address - Country:US
Practice Address - Phone:708-709-6535
Practice Address - Fax:708-709-6252
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70006838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146639Medicare ID - Type Unspecified