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General NPI Number Information
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NPI Number | 1295501930
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Entity Type | Organization
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Legal Business Name | TOGETHER WE GROW PEDIATRIC PHYSICAL THERAPY LTD
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 1164 CLINTON AVE
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City | OAK PARK
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State | IL
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Zip | 60304-1846
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Country | US
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Telephone | 314-704-4315
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Fax |
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Provider Business Mailing Address
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Address Line | 1164 CLINTON AVE
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City | OAK PARK
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State | IL
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Zip | 60304-1846
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PT AND OWNER
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Name | LAUREN K JOHNSON
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Credential | PT, DPT, PCS
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Telephone | 314-704-4315
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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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