Healthcare Provider Details

I. General information

NPI: 1598986077
Provider Name (Legal Business Name): FYSIOTHERAPIE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 W FULLERTON AVE
CHICAGO IL
60647-2915
US

IV. Provider business mailing address

200 N JEFFERSON ST APT 2401
CHICAGO IL
60661-1286
US

V. Phone/Fax

Practice location:
  • Phone: 773-342-8887
  • Fax:
Mailing address:
  • Phone: 312-207-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070013765
License Number StateIL

VIII. Authorized Official

Name: MR. SANJAY REDDY
Title or Position: PRESIDENT
Credential: PT
Phone: 312-207-1774