Provider Demographics
NPI:1134350820
Name:PLATT, PAMELA JEAN (PT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN
Last Name:PLATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 W LEON LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1642
Mailing Address - Country:US
Mailing Address - Phone:847-463-6201
Mailing Address - Fax:
Practice Address - Street 1:7900 N MILWAUKEE AVE STE 18
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3165
Practice Address - Country:US
Practice Address - Phone:847-965-3050
Practice Address - Fax:847-965-3052
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist