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General NPI Number Information
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NPI Number | 1093132771
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Entity Type | Organization
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Legal Business Name | FLOURISH PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 3717 N RAVENSWOOD AVE STE #213
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City | CHICAGO
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State | IL
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Zip | 60613-3880
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Country | US
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Telephone | 847-736-8357
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Fax | 773-348-7774
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Provider Business Mailing Address
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Address Line | 3524 N OAKLEY AVE
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City | CHICAGO
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State | IL
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Zip | 60618-6024
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Country | US
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Telephone | 847-736-8357
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Fax | 773-348-7774
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | DANA SACKAR
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Credential | MPT
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Telephone | 847-736-8357
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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 | 070011324
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License Number State | IL
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