Provider Demographics
NPI:1194054395
Name:VERSLUYS, ANN (PT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:VERSLUYS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KISH HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:895 S STATE ST STE 203
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-9600
Practice Address - Country:US
Practice Address - Phone:847-683-4358
Practice Address - Fax:847-683-3580
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist