Healthcare Provider Details

I. General information

NPI: 1952482515
Provider Name (Legal Business Name): PT WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N BOSWORTH
CHICAGO IL
60622
US

IV. Provider business mailing address

1315 N BOSWORTH
CHICAGO IL
60622
US

V. Phone/Fax

Practice location:
  • Phone: 773-203-1314
  • Fax: 773-395-2215
Mailing address:
  • Phone: 773-203-1314
  • Fax: 773-395-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070010529
License Number StateIL

VIII. Authorized Official

Name: MS. SARA BRIN KARP
Title or Position: PRESIDENT
Credential: MAST OF PHYS THERAPY
Phone: 773-203-1314