Doctor Name: | ELLEN WILDMAN |
NPI Number: | 1679972863 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 227.000470 |
Business Practice Address: | 5239 N Clark St 2nd Floor Chicago, IL - 606402122 |
Business Phone Number: | 7733347440 |
Business Fax Number: | |
Mailing Address: | 5239 N Clark St, 2nd Floor CHICAGO |
State: | IL |
Postal Code: | 606402122 |
Phone Number: | 7733347440 |
Fax Number: | |
NPI Enumeration Date: | 08/14/2014 |
NPI Last Update Date: | 08/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 227.000470 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |