Healthcare Provider Details

I. General information

NPI: 1689681520
Provider Name (Legal Business Name): WIEBUSCH PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N NORTH BRANCH ST
CHICAGO IL
60622-4278
US

IV. Provider business mailing address

1701 WEST WRIGHTWOOD AVENUE
CHICAGO IL
60614-7335
US

V. Phone/Fax

Practice location:
  • Phone: 773-750-7648
  • Fax: 773-327-7470
Mailing address:
  • Phone: 773-750-7648
  • Fax: 773-327-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TRACI WIEBUSCH HILL
Title or Position: PRESIDENT
Credential: MPT
Phone: 773-750-7648