| Diane Boquist, | |
|
28401 N Ballard Dr Ste G, Lake Forest, IL 60045-4543 | |
| (224) 212-0624 | |
| Not Available |
| Full Name | Diane Boquist |
|---|---|
| Gender | Female |
| Speciality | Physical Therapist |
| Location | 28401 N Ballard Dr Ste G, Lake Forest, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780088443 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 070.020983 (Illinois) | Primary |
| Provider Name | Vital Rehabilitation Association, Inc. |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1407858483 PECOS PAC ID: 4789672924 Enrollment ID: O20040505000643 |
| Provider Name | Athletico Ltd |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1821085028 PECOS PAC ID: 4789602681 Enrollment ID: O20120612000342 |
| Mailing Address | Practice Location Address |
|---|---|
| Diane Boquist, 28401 N Ballard Dr Ste G, Lake Forest, IL 60045-4543 Ph: (224) 212-0624 | Diane Boquist, 28401 N Ballard Dr Ste G, Lake Forest, IL 60045-4543 Ph: (224) 212-0624 |
Kelly Stanczak, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 225 E Deerpath, Lake Forest, IL 60045 Phone: 847-482-1433 Fax: 847-482-1483 | |
Eric L Soto, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1200 N Westmoreland Rd, Lake Forest, IL 60045 Phone: 847-535-7060 | |
Caroline Lang Overman, PT, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1000 N Westmoreland Rd, Lake Forest, IL 60045 Phone: 847-535-6430 Fax: 847-535-7259 | |
Jack Oscar Reed Smith, PT, DPT Physical Therapist Medicare: May Accept Medicare Assignments Practice Location: 1200 N Westmoreland Rd Ste 100, Lake Forest, IL 60045 Phone: 630-933-1500 | |
June Mccallister, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 660 N Westmoreland Rd, Lake Forest, IL 60045 Phone: 847-535-8833 Fax: 847-535-8830 | |
Laura Michelle Paschen, PTA Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1200 N Westmoreland Rd Ste 100, Lake Forest, IL 60045 Phone: 630-933-5000 | |
Dr. Kathryn Brito, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 800 N Westmoreland Rd Ste 200, Lake Forest, IL 60045 Phone: 224-271-5400 |