Basic Information
| Provider Information | |||||||||
| NPI: | 1750409637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASH | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2351 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | PEKIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615543972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093535940 | ||||||||
| FaxNumber: | 3093531654 | ||||||||
| Practice Location | |||||||||
| Address1: | 2351 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | PEKIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615543972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093535940 | ||||||||
| FaxNumber: | 3093531654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 05/27/2011 | ||||||||
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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 | 070005659 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | P00153845 | 01 | IL | RR MEDICARE PTAN | OTHER |