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General NPI Number Information
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NPI Number | 1235603945
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Entity Type | Organization
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Legal Business Name | MICKOW CE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 1200 OLD SKOKIE VALLEY RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3036
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Country | US
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Telephone | 847-748-8804
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Fax | 847-810-0046
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Provider Business Mailing Address
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Address Line | 167 GLENDALE ST
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City | WHEELING
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State | IL
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Zip | 60090-2933
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Country | US
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Telephone | 847-748-8804
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Fax | 847-810-0046
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHELSEA ELLIS
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Credential | PT
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Telephone | 847-748-8804
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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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