Healthcare Provider Details

I. General information

NPI: 1770116501
Provider Name (Legal Business Name): FULL ARMOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 JIM DR
SYCAMORE IL
60178-9513
US

IV. Provider business mailing address

1287 JIM DR
SYCAMORE IL
60178-9513
US

V. Phone/Fax

Practice location:
  • Phone: 815-710-6400
  • Fax:
Mailing address:
  • Phone: 815-710-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ADRIAN ESPINOSA
Title or Position: OWNER
Credential: PT
Phone: 815-710-6400