Provider Demographics
NPI:1699965608
Name:THORESEN, MILKA PETROVICH (PT DPT)
Entity type:Individual
Prefix:
First Name:MILKA
Middle Name:PETROVICH
Last Name:THORESEN
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 E HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-0532
Mailing Address - Country:US
Mailing Address - Phone:708-672-9066
Mailing Address - Fax:
Practice Address - Street 1:5548 S HYDE PARK BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1909
Practice Address - Country:US
Practice Address - Phone:773-256-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17873225100000X
IL070.015994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist