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General NPI Number Information
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NPI Number | 1073283453
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Entity Type | Organization
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Legal Business Name | PERSONAL PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 19071 W LAKE VIEW AVE
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City | MUNDELEIN
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State | IL
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Zip | 60060-3518
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Country | US
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Telephone | 916-260-6606
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Fax |
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Provider Business Mailing Address
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Address Line | 19071 W LAKE VIEW AVE
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City | MUNDELEIN
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State | IL
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Zip | 60060-3518
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUSTIN LEE SAWYER
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Credential | PT
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Telephone | 916-260-6606
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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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