Provider Demographics
NPI:1538325402
Name:KHAN, FARISA (PT)
Entity Type:Individual
Prefix:
First Name:FARISA
Middle Name:
Last Name:KHAN
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 1:1000 BURR RIDGE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0849
Mailing Address - Country:US
Mailing Address - Phone:630-920-4670
Mailing Address - Fax:
Practice Address - Street 1:1000 BURR RIDGE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0849
Practice Address - Country:US
Practice Address - Phone:630-920-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017767225100000X
IN05009637A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist