Healthcare Provider Details

I. General information

NPI: 1598204505
Provider Name (Legal Business Name): CHEBNY SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 N IL ROUTE 83 STE 116
GRAYSLAKE IL
60030-7928
US

IV. Provider business mailing address

1860 N IL ROUTE 83 STE 116
GRAYSLAKE IL
60030-7928
US

V. Phone/Fax

Practice location:
  • Phone: 242-252-2999
  • Fax: 224-252-2105
Mailing address:
  • Phone: 242-252-2999
  • Fax: 224-252-2105

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 Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTIAN JAMES CHEBNY
Title or Position: OWNER
Credential: PT, DPT
Phone: 224-456-0117