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General NPI Number Information
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NPI Number | 1184676835
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Entity Type | Organization
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Legal Business Name | CENTERIMT CHICAGO IL PC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 180 W. PARK AVE. STE. 250
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City | ELMHURST
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State | IL
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Zip | 60126-3357
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Country | US
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Telephone | 630-279-0032
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Fax | 630-279-1833
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Provider Business Mailing Address
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Address Line | 180 W. PARK AVE. STE. 250
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City | ELMHURST
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State | IL
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Zip | 60126-3357
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Country | US
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Telephone | 630-279-0032
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Fax | 630-279-1833
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MEEJUNG JANE PARK
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Credential | M.P.T., I.M.T., C.
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Telephone | 630-279-0032
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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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