Healthcare Provider Details

I. General information

NPI: 1639948011
Provider Name (Legal Business Name): ESCENDE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2643 W CHICAGO AVE
CHICAGO IL
60622-4519
US

IV. Provider business mailing address

2138 N POINT ST APT 2
CHICAGO IL
60647-7395
US

V. Phone/Fax

Practice location:
  • Phone: 773-661-6086
  • Fax:
Mailing address:
  • Phone: 405-639-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN B SOSANYA
Title or Position: OWNER/ MANAGER
Credential: DPT
Phone: 405-639-7074