Provider Demographics
NPI:1053400531
Name:ABELEDO DE MAS, NORA (PT)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:ABELEDO DE MAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:
Other - Last Name:MARINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:3240 E 84TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6549
Practice Address - Country:US
Practice Address - Phone:219-791-0494
Practice Address - Fax:219-791-0490
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003045A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233950OtherMEDICARE GROUP NUMBER
IN233950OtherMEDICARE GROUP NUMBER