Healthcare Provider Details

I. General information

NPI: 1356216626
Provider Name (Legal Business Name): FOX RIVER SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 S RANDALL RD
ALGONQUIN IL
60102-5933
US

IV. Provider business mailing address

1543 S RANDALL RD
ALGONQUIN IL
60102-5933
US

V. Phone/Fax

Practice location:
  • Phone: 224-241-8489
  • Fax:
Mailing address:
  • Phone: 224-241-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE BEVEL
Title or Position: MANAGING MEMBER
Credential:
Phone: 702-672-5105