Provider Demographics
NPI:1316398837
Name:BEDRONOVA, BOHUMILA
Entity Type:Individual
Prefix:
First Name:BOHUMILA
Middle Name:
Last Name:BEDRONOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 75TH ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7576
Mailing Address - Country:US
Mailing Address - Phone:630-481-7717
Mailing Address - Fax:
Practice Address - Street 1:846 75TH ST
Practice Address - Street 2:SUITE 114
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7576
Practice Address - Country:US
Practice Address - Phone:630-481-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.004223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist