Healthcare Provider Details

I. General information

NPI: 1124601331
Provider Name (Legal Business Name): SATELLITE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MCCLURG CT
CHICAGO IL
60611-3044
US

IV. Provider business mailing address

600 N MCCLURG CT APT 1712A
CHICAGO IL
60611-6774
US

V. Phone/Fax

Practice location:
  • Phone: 765-592-2283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KYLE PATRICK FAHEY
Title or Position: FOUNDER/PHYSICAL THERAPIST
Credential: DPT
Phone: 765-592-2283