Provider Demographics
NPI:1902123367
Name:ASSAF, RAMI (PTA)
Entity Type:Individual
Prefix:
First Name:RAMI
Middle Name:
Last Name:ASSAF
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CIRCLE AVE
Mailing Address - Street 2:UNIT 5 J
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1674
Mailing Address - Country:US
Mailing Address - Phone:773-910-6109
Mailing Address - Fax:
Practice Address - Street 1:3601 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3219
Practice Address - Country:US
Practice Address - Phone:708-749-4160
Practice Address - Fax:708-749-7696
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004130225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant