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General NPI Number Information
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NPI Number | 1073051017
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Entity Type | Organization
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Legal Business Name | COUNTER FORCE PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 1115 W ARMITAGE
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City | CHICAGO
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State | IL
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Zip | 60614
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Country | US
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Telephone | 773-234-1760
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Fax |
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Provider Business Mailing Address
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Address Line | 340 E NORTH WATER APARTMENT 3602
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 773-510-4312
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KONRAD KOCZWARA
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Credential |
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Telephone | 773-234-1760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 070.022449
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License Number State | IL
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