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General NPI Number Information
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NPI Number | 1356011589
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Entity Type | Individual
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Provider Name | ADAM FORSYTHE
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Gender | Male
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Dates
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Enumeration Date | 09/18/2021
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Last Update Date | 09/18/2021
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Provider Practice Location Address
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Address Line | 8700 31ST ST
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City | BROOKFIELD
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State | IL
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Zip | 60513-1000
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Country | US
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Telephone | 708-485-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 LATHROP AVE
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1338
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Country | US
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Telephone | 708-526-1612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160007027
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License Number State | IL
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