Healthcare Provider Details
I. General information
NPI: 1598337644
Provider Name (Legal Business Name): CITY NORTH PHYSICAL THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6232 N PULASKI RD
CHICAGO IL
60646-5132
US
IV. Provider business mailing address
710 N DEARBORN ST
CHICAGO IL
60654-5900
US
V. Phone/Fax
- Phone: 312-437-1129
- Fax:
- Phone: 312-819-2849
- Fax: 312-786-4669
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QP2000X |
| Taxonomy | Physical Therapy Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MARC
STRONGIN
Title or Position: OWNER
Credential: DC
Phone: 312-451-4913