Basic Information
| Provider Information | |||||||||
| NPI: | 1184071862 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FNU | ||||||||
| FirstName: | AANCHAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 ENTERPRISE DR | ||||||||
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| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305751980 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7967 CALUMET AVE | ||||||||
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| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463211215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2195130092 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05009439A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.