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General NPI Number Information
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NPI Number | 1245942556
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Entity Type | Organization
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Legal Business Name | EMPOWER ADVANCED THERAPY
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 407 E TERRA COTTA AVE STE E
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3602
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Country | US
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Telephone | 847-766-0011
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Fax | 847-999-6722
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Provider Business Mailing Address
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Address Line | 407 E TERRA COTTA AVE STE E
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3602
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Country | US
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Telephone | 847-766-0011
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Fax | 847-999-6722
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Authorized Official
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Title or Position | PART OWNER
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Name | YVONNE N GAGLIANO
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Credential | PT
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Telephone | 847-970-2592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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