=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326385477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENTROPY PHYSIOTHERAPY AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2013
-----------------------------------------------------
Last Update Date | 01/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1925 N CLYBOURN AVE SUITE 302
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60614-4946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-747-4070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1925 N CLYBOURN AVE SUITE 302
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60614-4946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-747-4070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST, CO-OWNER
-----------------------------------------------------
Name | DR. SARAH J HAAG
-----------------------------------------------------
Credential | PT, DPT, WCS
-----------------------------------------------------
Telephone | 773-747-4070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 40976785
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------