Provider Demographics
NPI:1558597716
Name:EMMERICH, WALDEMAR (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:WALDEMAR
Middle Name:
Last Name:EMMERICH
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W MONROE ST APT 407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2419
Mailing Address - Country:US
Mailing Address - Phone:312-492-6420
Mailing Address - Fax:
Practice Address - Street 1:4920 N KENMORE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3710
Practice Address - Country:US
Practice Address - Phone:773-769-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist