Provider Demographics
NPI:1740301365
Name:BARRY, PAULINE (DPT)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:TERADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1981
Mailing Address - Fax:630-928-5081
Practice Address - Street 1:24 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3668
Practice Address - Country:US
Practice Address - Phone:312-421-7274
Practice Address - Fax:312-421-7289
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist