Provider Demographics
NPI:1962803536
Name:SOLBERG, ANGELA (DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SOLBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BACCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:15312 W BELOIT RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7447
Practice Address - Country:US
Practice Address - Phone:262-641-5771
Practice Address - Fax:262-641-6317
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400314888Medicare PIN