Provider Demographics
NPI:1902970643
Name:SHAABNEH, FATEN (PT)
Entity Type:Individual
Prefix:
First Name:FATEN
Middle Name:
Last Name:SHAABNEH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6855 FORESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1640
Mailing Address - Country:US
Mailing Address - Phone:708-422-4441
Mailing Address - Fax:708-422-2122
Practice Address - Street 1:16651 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2581
Practice Address - Country:US
Practice Address - Phone:708-444-2467
Practice Address - Fax:708-444-2758
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859002Medicare PIN
IL214692002Medicare PIN