Active NPI
Lori Ann Havelka, PTA
- Physical Therapy Assistant
- Skokie, IL
National Provider Identifier
1104177286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.001163
- Practice address
- 8131 Monticello Ave
Skokie, IL 60076-3325 - Phone
- (847) 673-6767
- NPI assigned
- Sep 28, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.001163 | IL | Primary |
Addresses
Primary practice location
8131 Monticello Ave
Skokie, IL 60076-3325
Mailing address
5436 S Latrobe Ave
Chicago, IL 60638-2910
Phone (872) 800-4385
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.001163 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348790400000",
"number": "1104177286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5436 S LATROBE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606382910",
"telephone_number": "872-800-4385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8131 MONTICELLO AVE",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600763325",
"telephone_number": "847-673-6767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVELKA",
"first_name": "LORI",
"middle_name": "ANN",
"name_prefix": "Miss",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-28",
"last_updated": "2012-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.001163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Skokie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.