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General NPI Number Information
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NPI Number | 1255455986
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Entity Type | Organization
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Legal Business Name | WEESHINE PEDIATRIC PHYSICAL THERAPY, LTD
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1354 N MAPLEWOOD AVE SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60622-2827
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Country | US
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Telephone | 773-330-8025
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Fax | 773-256-9107
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Provider Business Mailing Address
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Address Line | 1354 N MAPLEWOOD AVE SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60622-2827
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Country | US
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Telephone | 773-330-8025
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Fax | 773-256-9107
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRISTON KEE
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Credential | PT
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Telephone | 773-330-8025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State | IL
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