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General NPI Number Information
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NPI Number | 1265295307
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Entity Type | Organization
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Legal Business Name | LONGSWORTH PHYSICAL THERAPY AND WELLNESS
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 1100 N BLUE MOUND RD STE 130
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City | SAGINAW
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State | TX
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Zip | 76131-4902
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Country | US
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Telephone | 773-707-8910
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Fax |
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Provider Business Mailing Address
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Address Line | 7212 W GREENLEAF ST
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City | NILES
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State | IL
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Zip | 60714-2116
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Country | US
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Telephone | 773-707-8910
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Fax |
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Authorized Official
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Title or Position | OWNER/ CEO
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Name | AMELIA SHARMAINE TING LONGSWORTH
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Credential | DPT
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Telephone | 773-707-8910
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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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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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