Healthcare Provider Details

I. General information

NPI: 1225547045
Provider Name (Legal Business Name): LINK PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 KEDZIE ST
EVANSTON IL
60202-2306
US

IV. Provider business mailing address

528 KEDZIE ST
EVANSTON IL
60202-2306
US

V. Phone/Fax

Practice location:
  • Phone: 773-791-5969
  • Fax: 847-905-0218
Mailing address:
  • Phone: 847-868-8396
  • Fax: 847-905-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070011033
License Number StateIL

VIII. Authorized Official

Name: SUZANNE ACERON BADILLO
Title or Position: OWNER
Credential: PT
Phone: 847-868-8396