Provider Demographics
NPI:1972189389
Name:ALM, MELINA MARY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:MARY
Last Name:ALM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:MARY
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:900 N WESTMORELAND RD STE LL50
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 N WESTMORELAND RD STE LL50
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1694
Practice Address - Country:US
Practice Address - Phone:224-271-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070025426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist