Provider Demographics
NPI:1982672481
Name:WEINSTEIN, ILENE (ATC)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 GREGORY ST
Mailing Address - Street 2:APT. E
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-2077
Mailing Address - Country:US
Mailing Address - Phone:708-774-2213
Mailing Address - Fax:
Practice Address - Street 1:132 GREGORY ST
Practice Address - Street 2:APT. E
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-2077
Practice Address - Country:US
Practice Address - Phone:708-774-2213
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960020412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer