Provider Demographics
NPI:1639368905
Name:TRIAS, MERILEE (PT)
Entity Type:Individual
Prefix:
First Name:MERILEE
Middle Name:
Last Name:TRIAS
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 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:4412 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4011
Practice Address - Country:US
Practice Address - Phone:773-847-3123
Practice Address - Fax:773-847-3778
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619980OtherBCBS OF IL
IL568080OtherMEDICARE
IL568150OtherMEDICARE GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
IL1619980OtherBCBS OF IL
IL568150OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE