Provider Demographics
NPI:1518579341
Name:GLANTSMAN, ALLA (CPTA)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:GLANTSMAN
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:SIROTKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3011 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4313
Mailing Address - Country:US
Mailing Address - Phone:847-322-1902
Mailing Address - Fax:
Practice Address - Street 1:1865 E BELVIDERE RD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2218
Practice Address - Country:US
Practice Address - Phone:224-338-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007690225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL160007690OtherPROFESSIONAL PTA LICENSE