Organization
ENGRAM
Active
Parent organization
ENGRAM
Other names
Engram Therapy and Wellness Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
ENGRAM
Authorized official
CARLA MAE R HAVERLAND PT, GCS (CEO)
(630) 729-4344
Entity
Organization
Contact information
Practice address
2655 W PETERSON AVE, CHICAGO, IL 60659-4017
(630) 729-4344
Mailing address
2655 W PETERSON AVE, CHICAGO, IL 60659-4017
(630) 729-4344
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184899072
—
IL
Enumeration date
09/08/2021
Last updated
04/01/2022
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