Healthcare Provider Details

I. General information

NPI: 1811818412
Provider Name (Legal Business Name): VITAL CORE PHYSICAL THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W HURON ST STE 300
CHICAGO IL
60654-3431
US

IV. Provider business mailing address

1758 W 18TH PL UNIT 1F
CHICAGO IL
60608-4427
US

V. Phone/Fax

Practice location:
  • Phone: 708-288-5212
  • Fax:
Mailing address:
  • Phone: 708-288-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA COVIAN-HERNANDEZ
Title or Position: OWNER
Credential: PT
Phone: 708-288-5212