Provider Demographics
NPI:1306162201
Name:SOBOL, MARIA JULIE (PT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:JULIE
Last Name:SOBOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:SOBOL
Other - Last Name:LOFTUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1729 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3704
Mailing Address - Country:US
Mailing Address - Phone:847-570-7170
Mailing Address - Fax:847-570-7172
Practice Address - Street 1:1729 BENSON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3704
Practice Address - Country:US
Practice Address - Phone:847-570-7170
Practice Address - Fax:847-570-7172
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070002141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist