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General NPI Number Information
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NPI Number | 1073169777
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Entity Type | Organization
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Legal Business Name | LAKEFRONT PT LLC
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Dates
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Enumeration Date | 08/18/2019
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 71 S WACKER DR # 200A
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City | CHICAGO
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State | IL
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Zip | 60606-4637
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Country | US
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Telephone | 765-744-6354
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Fax |
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Provider Business Mailing Address
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Address Line | 201 N WESTSHORE DR APT 1602
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City | CHICAGO
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State | IL
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Zip | 60601-7262
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Country | US
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Telephone | 765-744-6354
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. BILL R HITCHCOCK
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Credential | PT
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Telephone | 765-744-6354
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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 |
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License Number State |
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