Provider Demographics
NPI:1972699759
Name:PING, MYRA K (PT,MS)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:K
Last Name:PING
Suffix:
Gender:F
Credentials:PT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 N WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2607
Mailing Address - Country:US
Mailing Address - Phone:773-549-5475
Mailing Address - Fax:773-549-5630
Practice Address - Street 1:3941 N WAYNE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2607
Practice Address - Country:US
Practice Address - Phone:773-244-0600
Practice Address - Fax:773-549-5630
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
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
IL01608398OtherBLUE CROSS / BLUE SHIELD