Individual
ANTONIETTA MANSFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
355 RIDGE AVE, EVANSTON, IL 60202-3328
(847) 316-6283
(847) 316-2758
Mailing address
355 RIDGE AVE, EVANSTON, IL 60202-3328
(847) 316-6283
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
0300411
NY
225100000X
Physical Therapist
Primary
070016708
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619980
BCBS OF IL
IL
Enumeration date
02/27/2008
Last updated
02/20/2018
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