Provider Demographics
NPI:1902962053
Name:WESTERHOFF, MARIJO (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIJO
Middle Name:
Last Name:WESTERHOFF
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15209 LAS ROBLES ST
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1713
Mailing Address - Country:US
Mailing Address - Phone:708-535-6730
Mailing Address - Fax:708-535-6730
Practice Address - Street 1:9735 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3614
Practice Address - Country:US
Practice Address - Phone:708-424-7920
Practice Address - Fax:708-424-4597
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant