Provider Demographics
NPI:1992870505
Name:AVENA-OLANO, ANNA G (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:G
Last Name:AVENA-OLANO
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 1:1523 KINGSTON LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2537
Mailing Address - Country:US
Mailing Address - Phone:630-478-5240
Mailing Address - Fax:
Practice Address - Street 1:125 S WILKE RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1521
Practice Address - Country:US
Practice Address - Phone:630-478-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-008093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK03977Medicare ID - Type UnspecifiedMCARE LOC016
ILP00194744Medicare PIN
IL208325007Medicare PIN
ILK03976Medicare ID - Type UnspecifiedMCARE LOC015