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NPI Code Detail

MEDICARE: BOUNDLESS HEALTH, LLC

MEDICARE: BOUNDLESS HEALTH, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical Therapist070013293IL

General Provider Information

NPI Number : 1790079077
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOUNDLESS HEALTH, LLC
Provider Business Mailing Address
First Line : 516 N OGDEN AVE
Second Line : #203
City : CHICAGO
State : IL
Zip : 60642-6421
Country : US
Telephone Number : 773-562-0907
Fax Number : 312-488-3651
Provider Business Practice Location Address
First Line : 2929 N SOUTHPORT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6945
Country : US
Telephone Number : 312-566-8460
Fax Number :
Authorized Official
Title or Position : OWNER, PHYSICAL THERAPIST
Name : JESSICA BRELJE
Credential : MPT
Telephone Number : 773-562-0907
Provider Enumeration Date : 06/04/2011
Last Update Date : 06/04/2011

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Directions to “BOUNDLESS HEALTH, LLC ” Practice Location

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