Provider Demographics
NPI:1629002779
Name:SHEMESH, ANDREA KOREN (PT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:KOREN
Last Name:SHEMESH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:KOREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:259 E ERIE ST STE 2450
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2987
Mailing Address - Country:US
Mailing Address - Phone:312-694-6447
Mailing Address - Fax:
Practice Address - Street 1:259 E ERIE ST STE 2450
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2987
Practice Address - Country:US
Practice Address - Phone:312-694-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist