Basic Information
| Provider Information | |||||||||
| NPI: | 1225302607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASH | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 RANDALL RD | ||||||||
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| City: | GENEVA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601344200 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 296 RANDALL RD | ||||||||
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| City: | GENEVA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601344203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302084215 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2012 | ||||||||
| LastUpdateDate: | 06/22/2015 | ||||||||
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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 | 225200000X | 160.004546 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.