Individual
MS. GRETCHEN L SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
6500 W 65TH ST, CHICAGO, IL 60638-4962
(708) 496-1515
Mailing address
3928 N PAULINA ST, APT 2, CHICAGO, IL 60613-2518
(216) 246-7103
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
010500
OH
225100000X
Physical Therapist
Primary
070.016147
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217473
ANTHEMBLUECROSS/BLUESHIEL
OH
05
—
0842995
—
OH
Enumeration date
09/21/2006
Last updated
09/27/2012
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