Healthcare Provider Details

I. General information

NPI: 1528384971
Provider Name (Legal Business Name): NEW CITY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 W CERMAK RD
CHICAGO IL
60608-3515
US

IV. Provider business mailing address

2644 W CERMAK RD
CHICAGO IL
60608-3515
US

V. Phone/Fax

Practice location:
  • Phone: 773-805-8314
  • Fax: 773-523-2520
Mailing address:
  • Phone: 773-805-8314
  • Fax: 773-523-2520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070006056
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056003500
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227011382
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIA I. REYES
Title or Position: PRESIDENT
Credential:
Phone: 773-805-8314