Provider Demographics
NPI:1912023912
Name:WEINSTEIN, FAYE H (MMSC, PT)
Entity Type:Individual
Prefix:MRS
First Name:FAYE
Middle Name:H
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:MMSC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 N HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1015
Mailing Address - Country:US
Mailing Address - Phone:773-478-5549
Mailing Address - Fax:773-478-5786
Practice Address - Street 1:4320 N HARDING AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1015
Practice Address - Country:US
Practice Address - Phone:773-478-5549
Practice Address - Fax:773-478-5786
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL100044415-62762-01OtherDHS- EARLY INTERVENTION