Provider Demographics
NPI:1972855815
Name:PAVEL, ILEA K (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ILEA
Middle Name:K
Last Name:PAVEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:ILEA
Other - Middle Name:M
Other - Last Name:KNEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1113 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2338
Mailing Address - Country:US
Mailing Address - Phone:630-567-4532
Mailing Address - Fax:
Practice Address - Street 1:1200 S YORK RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5626
Practice Address - Country:US
Practice Address - Phone:630-758-8111
Practice Address - Fax:630-758-8387
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist