Healthcare Provider Details

I. General information

NPI: 1578105409
Provider Name (Legal Business Name): ABIGAIL POLIVKA LORBER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W BELMONT AVE STE 350
CHICAGO IL
60657-5785
US

IV. Provider business mailing address

1333 W BELMONT AVE STE 350
CHICAGO IL
60657-5785
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-8810
  • Fax: 312-694-9361
Mailing address:
  • Phone: 312-926-8810
  • Fax: 312-694-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070024772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: