Provider Demographics
NPI:1194751347
Name:STANK, SUSAN K (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:STANK
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 1:5005 NEWPORT DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3832
Mailing Address - Country:US
Mailing Address - Phone:847-797-1050
Mailing Address - Fax:847-797-1337
Practice Address - Street 1:2500 N MAYFAIR RD
Practice Address - Street 2:SUITE 480
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1409
Practice Address - Country:US
Practice Address - Phone:414-475-6043
Practice Address - Fax:414-475-6098
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4943-024225100000X
IL070010573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist