Provider Demographics
NPI:1639407257
Name:ILAR, NANCY CHASE HAWES (PT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:CHASE HAWES
Last Name:ILAR
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 1:16258 W FAWN LN
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-3515
Mailing Address - Country:US
Mailing Address - Phone:715-634-2720
Mailing Address - Fax:
Practice Address - Street 1:16258 W FAWN LN
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-3515
Practice Address - Country:US
Practice Address - Phone:715-634-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11349-024225100000X
IL070.005873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist