Provider Demographics
NPI:1487355392
Name:ARDISANA, KAREN L (PTA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:ARDISANA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HARGER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1400
Mailing Address - Country:US
Mailing Address - Phone:630-928-1430
Mailing Address - Fax:630-925-1424
Practice Address - Street 1:915 HARGER RD STE 102
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1400
Practice Address - Country:US
Practice Address - Phone:630-928-1430
Practice Address - Fax:630-925-1424
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.002126225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty