Provider Demographics
NPI:1265404313
Name:ABRAHAM, SHARL W (DPT, ECS, RNCST)
Entity type:Individual
Prefix:
First Name:SHARL
Middle Name:W
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:DPT, ECS, RNCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 N RANDALL RD STE 280
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7901
Mailing Address - Country:US
Mailing Address - Phone:224-535-9453
Mailing Address - Fax:630-883-8730
Practice Address - Street 1:1750 N RANDALL RD STE 280
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7901
Practice Address - Country:US
Practice Address - Phone:224-535-9453
Practice Address - Fax:630-883-8730
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070 014265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist