Organization
FUNCTIONAL PILATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA ANN SHEADE OTR/L (OWNER)
(847) 612-0530
Entity
Organization
Contact information
Practice address
1725 S CALIFORNIA AVE, PALATINE, IL 60067-7527
(847) 612-0530
Mailing address
1725 S CALIFORNIA AVE, PALATINE, IL 60067-7527
(847) 612-0530
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056009012
APPLYING TO BCBS NETWORK
IL
Enumeration date
12/29/2022
Last updated
12/29/2022
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