Provider Demographics
NPI:1427089739
Name:EARL, TABIA (PT)
Entity type:Individual
Prefix:
First Name:TABIA
Middle Name:
Last Name:EARL
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 1:10 W MARTIN AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6590
Mailing Address - Country:US
Mailing Address - Phone:630-848-1744
Mailing Address - Fax:630-848-1745
Practice Address - Street 1:10 W MARTIN AVE STE 226
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6590
Practice Address - Country:US
Practice Address - Phone:630-848-1744
Practice Address - Fax:630-848-1745
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232697OtherBCBS
ILK26049Medicare PIN
IL2232697OtherBCBS