Healthcare Provider Details

I. General information

NPI: 1740657121
Provider Name (Legal Business Name): BENJAMIN TOH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 W MONTROSE AVE
CHICAGO IL
60641-1331
US

IV. Provider business mailing address

5545 W MONTROSE AVE
CHICAGO IL
60641-1331
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-6648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070021603
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: