Provider Demographics
NPI:1740683804
Name:CUARTEROS, ANNALYN
Entity type:Individual
Prefix:
First Name:ANNALYN
Middle Name:
Last Name:CUARTEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HARVESTER DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5919
Mailing Address - Country:US
Mailing Address - Phone:630-246-5100
Mailing Address - Fax:630-246-5119
Practice Address - Street 1:6170 JOLIET RD
Practice Address - Street 2:LAGRANGE MEDICAL CENTER
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3976
Practice Address - Country:US
Practice Address - Phone:708-352-0330
Practice Address - Fax:708-352-8905
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist