Provider Demographics
NPI:1487117784
Name:SOMARRIBA, CLAIRE (PTA)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:SOMARRIBA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 GUNNISON CT
Mailing Address - Street 2:
Mailing Address - City:GILBERTS
Mailing Address - State:IL
Mailing Address - Zip Code:60136-4083
Mailing Address - Country:US
Mailing Address - Phone:224-523-0093
Mailing Address - Fax:
Practice Address - Street 1:4101 LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1112
Practice Address - Country:US
Practice Address - Phone:847-562-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160006472208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation