Healthcare Provider Details

I. General information

NPI: 1528810421
Provider Name (Legal Business Name): BEVERLY PHYSICAL THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 W 95TH ST
CHICAGO IL
60643-1001
US

IV. Provider business mailing address

710 N DEARBORN ST
CHICAGO IL
60654-5900
US

V. Phone/Fax

Practice location:
  • Phone: 773-288-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEFANIE SHAW
Title or Position: CEO
Credential:
Phone: 312-437-1129