Provider Demographics
NPI:1104651868
Name:HEINZ, SILVANA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SILVANA
Middle Name:
Last Name:HEINZ
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 1:1122 N CLARK ST APT 1908
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2865
Mailing Address - Country:US
Mailing Address - Phone:609-784-6312
Mailing Address - Fax:
Practice Address - Street 1:600 W CHICAGO AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-2802
Practice Address - Country:US
Practice Address - Phone:312-625-0845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.028524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist