Provider Demographics
NPI:1316505142
Name:RAMIREZ, EDMAR
Entity type:Individual
Prefix:
First Name:EDMAR
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15782 MUELLER WAY
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-5424
Mailing Address - Country:US
Mailing Address - Phone:708-205-3171
Mailing Address - Fax:
Practice Address - Street 1:15782 MUELLER WAY
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-5424
Practice Address - Country:US
Practice Address - Phone:708-205-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist