Provider Demographics
NPI:1457823858
Name:KOHEN, ALBERT (LMT)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:KOHEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MILWAUKEE AVE STE 341
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3589
Mailing Address - Country:US
Mailing Address - Phone:847-542-0510
Mailing Address - Fax:
Practice Address - Street 1:1020 MILWAUKEE AVE STE 341
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3589
Practice Address - Country:US
Practice Address - Phone:847-542-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227015150225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist