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General NPI Number Information
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NPI Number | 1184349995
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Entity Type | Organization
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Legal Business Name | MY PELVIC THERAPY, PLLC
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 249 N LINCOLN AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-3121
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Country | US
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Telephone | 224-255-7678
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Fax | 224-985-2038
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Provider Business Mailing Address
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Address Line | 249 N LINCOLN AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-3121
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Country | US
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Telephone | 224-255-7678
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Fax | 224-985-2038
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Authorized Official
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Title or Position | MANAGER AND PHYSICAL THERAPIST
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Name | ANGELA FISHMAN
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Credential | PT
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Telephone | 224-255-7678
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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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