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General NPI Number Information
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NPI Number | 1043572084
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Entity Type | Organization
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Legal Business Name | LOU ANN GOLDSTEIN PT
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 1843 W BARRY AVE
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City | CHICAGO
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State | IL
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Zip | 60657-2042
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Country | US
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Telephone | 773-502-7601
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Fax | 773-672-4881
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Provider Business Mailing Address
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Address Line | 1843 W BARRY AVE
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City | CHICAGO
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State | IL
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Zip | 60657-2042
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Country | US
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Telephone | 773-502-7601
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Fax | 773-672-4881
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. LOU ANN GOLDSTEIN
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Credential |
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Telephone | 773-502-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 070008505
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License Number State | IL
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