Healthcare Provider Details

I. General information

NPI: 1285635532
Provider Name (Legal Business Name): THERAPY PLUS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 N DAMEN AVE
CHICAGO IL
60625-1442
US

IV. Provider business mailing address

4733 N DAMEN AVE
CHICAGO IL
60625-1442
US

V. Phone/Fax

Practice location:
  • Phone: 773-743-4881
  • Fax: 773-751-2878
Mailing address:
  • Phone: 773-743-4881
  • Fax: 773-751-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number070-010042
License Number StateIL

VIII. Authorized Official

Name: BETTY CARRENO
Title or Position: OWNER
Credential: LPT
Phone: 773-316-5305