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General NPI Number Information
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NPI Number | 1285635532
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Entity Type | Organization
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Legal Business Name | THERAPY PLUS PC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 4733 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-1442
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Country | US
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Telephone | 773-743-4881
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Fax | 773-751-2878
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Provider Business Mailing Address
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Address Line | 4733 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-1442
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Country | US
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Telephone | 773-743-4881
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Fax | 773-751-2878
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Authorized Official
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Title or Position | OWNER
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Name | BETTY CARRENO
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Credential | LPT
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Telephone | 773-316-5305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 070-010042
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License Number State | IL
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