Provider Demographics
NPI:1184759219
Name:VINAJA, PATRICIA A (PT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:VINAJA
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 1:1726 N 77TH CT
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4110
Mailing Address - Country:US
Mailing Address - Phone:708-456-3548
Mailing Address - Fax:
Practice Address - Street 1:1951 W 19TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2647
Practice Address - Country:US
Practice Address - Phone:312-997-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251P0200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Not Answered174400000XOther Service ProvidersSpecialist