Healthcare Provider Details

I. General information

NPI: 1255455986
Provider Name (Legal Business Name): WEESHINE PEDIATRIC PHYSICAL THERAPY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 N MAPLEWOOD AVE SUITE 1
CHICAGO IL
60622-2827
US

IV. Provider business mailing address

1354 N MAPLEWOOD AVE SUITE 1
CHICAGO IL
60622-2827
US

V. Phone/Fax

Practice location:
  • Phone: 773-330-8025
  • Fax: 773-256-9107
Mailing address:
  • Phone: 773-330-8025
  • Fax: 773-256-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name: TRISTON KEE
Title or Position: PRESIDENT
Credential: PT
Phone: 773-330-8025