Provider Demographics
NPI:1730186248
Name:DEANA HERRMAN & PATRICE LASSA, PC
Entity type:Organization
Organization Name:DEANA HERRMAN & PATRICE LASSA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:312-386-9028
Mailing Address - Street 1:819 S WABASH AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2188
Mailing Address - Country:US
Mailing Address - Phone:312-386-9028
Mailing Address - Fax:
Practice Address - Street 1:819 S WABASH AVE
Practice Address - Street 2:STE 208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2188
Practice Address - Country:US
Practice Address - Phone:312-386-9028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209472Medicare ID - Type Unspecified