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General NPI Number Information
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NPI Number | 1104309426
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Entity Type | Organization
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Legal Business Name | KIDS IN BALANCE LLC
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 2312 W MEDILL AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60647-3234
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Country | US
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Telephone | 773-405-6020
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Fax | 877-217-2357
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Provider Business Mailing Address
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Address Line | 2312 W MEDILL AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60647-3234
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Country | US
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Telephone | 773-405-6020
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | EVETTE COLL
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Credential | PT
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Telephone | 773-405-6020
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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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