Basic Information
| Provider Information | |||||||||
| NPI: | 1982700738 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANIMA | ||||||||
| FirstName: | ARMANDO | ||||||||
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| Credential: | KT-OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 318 KENLOCH AVE | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600481772 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 GREEN BAY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600643048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476881900 | ||||||||
| FaxNumber: | 2246103706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 226300000X | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Kinesiotherapist | 225X00000X | IL | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.