Provider Demographics
NPI:1144581802
Name:SIEGEL, HAVIVA BATSHEVA (DPT, PT)
Entity type:Individual
Prefix:
First Name:HAVIVA
Middle Name:BATSHEVA
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2104
Mailing Address - Country:US
Mailing Address - Phone:630-240-1817
Mailing Address - Fax:888-977-2018
Practice Address - Street 1:1020 S EAST AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2104
Practice Address - Country:US
Practice Address - Phone:630-240-1817
Practice Address - Fax:888-977-2018
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid