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General NPI Number Information
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NPI Number | 1295367084
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Entity Type | Organization
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Legal Business Name | MY BODY MECHANIC, LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 4007 N KENMORE AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60613-2092
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Country | US
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Telephone | 773-458-3835
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Fax |
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Provider Business Mailing Address
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Address Line | 4007 N KENMORE AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60613-2092
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Country | US
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Telephone | 773-458-3835
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | CORISSA J KEEFNER
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Credential | PT, DPT
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Telephone | 773-458-3835
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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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