Provider Demographics
NPI:1326026402
Name:CARLSON, DARLENE MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARIE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSPT
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 1:420 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3241
Practice Address - Country:US
Practice Address - Phone:815-834-9901
Practice Address - Fax:815-834-9904
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0087612251X0800X
IL070008761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619980OtherBCBS OF IL
IL1619980OtherBCBS OF IL
IL568150Medicare PIN
ILR03756Medicare PIN
IL568080Medicare PIN
ILR03755Medicare PIN
IL567700Medicare PIN