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General NPI Number Information
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NPI Number | 1265790638
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Entity Type | Organization
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Legal Business Name | INNOVATIVE THERAPY SOLUTIONS, LLC
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 9912 S FOREST AVE
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City | CHICAGO
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State | IL
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Zip | 60628-1440
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Country | US
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Telephone | 773-941-9245
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Fax | 773-821-0396
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Provider Business Mailing Address
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Address Line | 9912 S FOREST AVE
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City | CHICAGO
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State | IL
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Zip | 60628-1440
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Country | US
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Telephone |
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Fax | 773-821-0396
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JAMEKA LATRICE WILLIAMS-MUHAMMAD
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Credential | MPT
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Telephone | 773-941-9245
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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 | 070015850
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License Number State | IL
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