Provider Demographics
NPI:1821318700
Name:HORBACH, PAMELA RUTH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:RUTH
Last Name:HORBACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:RUTH
Other - Last Name:RANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:13056 S BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60633-1321
Mailing Address - Country:US
Mailing Address - Phone:773-720-1171
Mailing Address - Fax:
Practice Address - Street 1:20110 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1030
Practice Address - Country:US
Practice Address - Phone:708-503-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017751225100000X
IN05010073A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist