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General NPI Number Information
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NPI Number | 1104391028
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Entity Type | Organization
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Legal Business Name | ADAPT PHYSICAL THERAPY AND SPORTS PERFORMANCE, PLLC
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Dates
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Enumeration Date | 10/07/2018
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 6323 N AVONDALE AVE STE B-243
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City | CHICAGO
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State | IL
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Zip | 60631-1962
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Country | US
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Telephone | 847-305-4507
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Fax | 773-887-0017
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Provider Business Mailing Address
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Address Line | 6323 N AVONDALE AVE STE B-243
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City | CHICAGO
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State | IL
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Zip | 60631-1962
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Country | US
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Telephone | 847-305-4507
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Fax | 773-887-0017
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Authorized Official
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Title or Position | OWNER
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Name | DR. FREDERICK DUANE SAMPANG
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Credential | PT, DPT
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Telephone | 847-293-8171
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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 |
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License Number State |
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