Provider Demographics
NPI:1720882152
Name:RAZVI, ASRA MAMSA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASRA
Middle Name:MAMSA
Last Name:RAZVI
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ASRA
Other - Middle Name:
Other - Last Name:MAMSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7113 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2179
Mailing Address - Country:US
Mailing Address - Phone:630-999-7575
Mailing Address - Fax:
Practice Address - Street 1:701 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1699
Practice Address - Country:US
Practice Address - Phone:708-681-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist