Healthcare Provider Details

I. General information

NPI: 1538947494
Provider Name (Legal Business Name): ROOT THERAPEUTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SHERWOOD TER STE 51H
LAKE BLUFF IL
60044-2232
US

IV. Provider business mailing address

840 N SAINT MARYS RD
LIBERTYVILLE IL
60048-1634
US

V. Phone/Fax

Practice location:
  • Phone: 312-554-5709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIKA TOEBAAS
Title or Position: OWNER
Credential: L.AC
Phone: 773-443-3809