Provider Demographics
NPI:1871617324
Name:PITTALA, MAIDHILI RANI (PT)
Entity type:Individual
Prefix:
First Name:MAIDHILI
Middle Name:RANI
Last Name:PITTALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N JANE DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5118
Mailing Address - Country:US
Mailing Address - Phone:847-760-6639
Mailing Address - Fax:847-760-6640
Practice Address - Street 1:50 N JANE DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5118
Practice Address - Country:US
Practice Address - Phone:847-760-6639
Practice Address - Fax:847-760-6640
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist