Provider Demographics
NPI:1609356658
Name:PIGGEE, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:PIGGEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:PHILIZAIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1040 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-2690
Mailing Address - Country:US
Mailing Address - Phone:696-170-8300
Mailing Address - Fax:515-708-9723
Practice Address - Street 1:1040 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2690
Practice Address - Country:US
Practice Address - Phone:708-300-6961
Practice Address - Fax:708-515-9723
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.021892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist