Provider Demographics
NPI:1194776229
Name:KABBANI, BEATTA (PT)
Entity type:Individual
Prefix:DR
First Name:BEATTA
Middle Name:
Last Name:KABBANI
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:PO BOX 76, GLENVIEW, IL 60025
Mailing Address - Street 2:211 WAUKEGAN ROAD
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2747
Mailing Address - Country:US
Mailing Address - Phone:847-724-7600
Mailing Address - Fax:847-724-7693
Practice Address - Street 1:211 WAUKEGAN RD
Practice Address - Street 2:STE 300
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2757
Practice Address - Country:US
Practice Address - Phone:847-724-7600
Practice Address - Fax:847-724-7693
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70006734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK07853Medicare PIN
IL209349Medicare PIN
144528Medicare ID - Type Unspecified