Healthcare Provider Details

I. General information

NPI: 1780058479
Provider Name (Legal Business Name): LIVING BEYOND THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19806 KILKENNY AVE
TINLEY PARK IL
60487-4415
US

IV. Provider business mailing address

1921 RIDGE RD PO BOX 980
HOMEWOOD IL
60430-4614
US

V. Phone/Fax

Practice location:
  • Phone: 708-898-4777
  • Fax: 708-880-4202
Mailing address:
  • Phone: 708-898-4777
  • Fax: 708-880-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070016737
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070015213
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number056002536
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146007427
License Number StateIL

VIII. Authorized Official

Name: MR. YUNDEE YNGSON
Title or Position: OPERATIONS OFFICER
Credential: PT
Phone: 708-898-4777