Provider Demographics
NPI:1184842205
Name:EVIOTA, AILEEN JOY C (PT)
Entity Type:Individual
Prefix:
First Name:AILEEN JOY
Middle Name:C
Last Name:EVIOTA
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 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:1145 WESTGATE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1089
Practice Address - Country:US
Practice Address - Phone:708-763-0564
Practice Address - Fax:708-763-8739
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist