Provider Demographics
NPI:1306312152
Name:DEVILLA, MARYANN ALMORES (DPT)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:ALMORES
Last Name:DEVILLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 E CRABTREE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2709
Mailing Address - Country:US
Mailing Address - Phone:847-912-4902
Mailing Address - Fax:
Practice Address - Street 1:SUNRISE ASSISTED LIVING
Practice Address - Street 2:1725 BALLARD ROAD
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-824-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006946208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation