Individual
MS. DAISY TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1675 DEMPSTER ST FL 3, PARK RIDGE, IL 60068-1110
(847) 318-9330
(847) 723-9441
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
(847) 390-5450
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
070-012750
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1617235
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/20/2007
Last updated
09/12/2022
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