Healthcare Provider Details

I. General information

NPI: 1669172961
Provider Name (Legal Business Name): BERWYN PHYSICAL THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6544 CERMAK RD UNIT 2
BERWYN IL
60402-2324
US

IV. Provider business mailing address

PO BOX 10693
CHICAGO IL
60610-0693
US

V. Phone/Fax

Practice location:
  • Phone: 708-637-4273
  • Fax: 773-634-8295
Mailing address:
  • Phone: 708-637-4273
  • Fax: 773-634-8295

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: STEFANIE SHAW
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 312-437-1129