Provider Demographics
NPI:1841335056
Name:MARTIN, PATRICIA (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:520 E BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2181
Practice Address - Country:US
Practice Address - Phone:630-783-2438
Practice Address - Fax:630-739-2589
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-006253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11775364OtherCAQH
IN1275738221OtherNPI
IN000000535153OtherANTHEM BC/BS
IN0007714984OtherAETNA
IN089937OtherSIHO
IN260374180100OtherPYRAMID TODAYS OPTIONS
IN260374180OtherCHOICECARE NETWORK
IN38856OtherIHN
IN260374180OtherCHOICECARE NETWORK