Provider Demographics
NPI:1396260774
Name:ADAME, YAZMIN (PTA)
Entity type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:ADAME
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 WESTCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-4338
Mailing Address - Country:US
Mailing Address - Phone:773-818-3911
Mailing Address - Fax:
Practice Address - Street 1:2106 WESTCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-4338
Practice Address - Country:US
Practice Address - Phone:708-336-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007906225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant