Provider Demographics
NPI:1952436933
Name:WERNER, LUCY (PTA)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:WERNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:GOCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:5100 CARRIAGEWAY DR
Mailing Address - Street 2:UNIT 105
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5100 CARRIAGEWAY DR
Practice Address - Street 2:UNIT 105
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3986
Practice Address - Country:US
Practice Address - Phone:773-814-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant