Individual
MICHAEL HEADTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1256 W BOUGHTON RD, BOLINGBROOK, IL 60440-6568
(630) 378-9420
(630) 378-9169
Mailing address
1256 W BOUGHTON RD, BOLINGBROOK, IL 60440-6568
(630) 378-9420
(630) 378-9169
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160-004997
IL
Other
Enumeration date
05/27/2009
Last updated
05/27/2009
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