Healthcare Provider Details

I. General information

NPI: 1770931842
Provider Name (Legal Business Name): ERIN MARIE SHORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4657 N LINCOLN AVE
CHICAGO IL
60625-2024
US

IV. Provider business mailing address

5138 N CLAREMONT AVE APT 3
CHICAGO IL
60625-1884
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-6472
  • Fax:
Mailing address:
  • Phone: 630-621-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070.022213
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: