1770701823 NPI number — SHARI RUTH FOSSIER PT

Table of content: SHARI RUTH FOSSIER PT (NPI 1770701823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770701823 NPI number — SHARI RUTH FOSSIER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSSIER
Provider First Name:
SHARI RUTH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770701823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 W WACKER DR
Provider Second Line Business Mailing Address:
SUITE 1020
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60606-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-640-0329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1012 95TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60564-5041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-428-1503
Provider Business Practice Location Address Fax Number:
630-428-1542
Provider Enumeration Date:
04/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070011811 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)