Provider Demographics
NPI:1265608830
Name:ABBINANTI GLOMB, DOREEN (PTA)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:ABBINANTI GLOMB
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:
Other - Last Name:GLOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:9886 W 145TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2412
Mailing Address - Country:US
Mailing Address - Phone:708-349-6544
Mailing Address - Fax:708-349-7994
Practice Address - Street 1:16170 KINGSPORT RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5602
Practice Address - Country:US
Practice Address - Phone:708-349-6544
Practice Address - Fax:708-349-7994
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004891225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant