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General NPI Number Information
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NPI Number | 1174374235
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Entity Type | Organization
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Legal Business Name | IRON MIND REHAB AND PERFORMANCE LLC
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 2861 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-8201
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Country | US
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Telephone | 314-698-7594
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Fax |
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Provider Business Mailing Address
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Address Line | 1712 W WILSON AVE APT 3E
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City | CHICAGO
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State | IL
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Zip | 60640-4540
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Country | US
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Telephone | 314-698-7594
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | REBECCA WARD
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Credential | DPT
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Telephone | 314-698-7594
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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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