Provider Demographics
NPI:1215086319
Name:ASHBECK, TINAMARIE J
Entity type:Individual
Prefix:
First Name:TINAMARIE
Middle Name:J
Last Name:ASHBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2743
Mailing Address - Country:US
Mailing Address - Phone:847-295-1223
Mailing Address - Fax:
Practice Address - Street 1:809 W EVERETT RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2743
Practice Address - Country:US
Practice Address - Phone:847-295-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist