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General NPI Number Information
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NPI Number | 1255972535
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Entity Type | Organization
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Legal Business Name | POSTURE PALOOZA
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 840 S WAUKEGAN RD STE 212
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City | LAKE FOREST
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State | IL
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Zip | 60045-2619
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Country | US
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Telephone | 847-455-6674
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Fax |
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Provider Business Mailing Address
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Address Line | 840 S WAUKEGAN RD STE 212
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City | LAKE FOREST
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State | IL
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Zip | 60045-2619
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Country | US
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Telephone | 847-455-6674
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELLEN HUMPHREY
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Credential |
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Telephone | 847-455-6674
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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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