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General NPI Number Information
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NPI Number | 1053677922
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Entity Type | Organization
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Legal Business Name | ADVANCED THERAPEUTIC MOTION, P.C.
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 1820 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613-2406
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Country | US
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Telephone | 773-852-3335
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Fax | 773-313-3538
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Provider Business Mailing Address
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Address Line | 1820 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613-2406
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Country | US
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Telephone | 773-852-3335
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Fax | 773-313-3538
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL JACOBAZZI
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Credential | P.T.
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Telephone | 773-316-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070018357
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License Number State | IL
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