Provider Demographics
NPI:1104152867
Name:WILK, LYDIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:WILK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COMMERCE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8865
Mailing Address - Country:US
Mailing Address - Phone:630-933-1500
Mailing Address - Fax:331-732-4581
Practice Address - Street 1:1001 COMMERCE DR STE 600
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-8865
Practice Address - Country:US
Practice Address - Phone:630-933-1500
Practice Address - Fax:331-732-4581
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist