Healthcare Provider Details

I. General information

NPI: 1043023229
Provider Name (Legal Business Name): SAMANTHA STARSICK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

940 N OAK PARK AVE
OAK PARK IL
60302-1324
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7453
  • Fax:
Mailing address:
  • Phone: 630-901-3041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number070.015711
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: