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General NPI Number Information
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NPI Number | 1437628591
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Entity Type | Organization
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Legal Business Name | WEST SUBURBAN PHYSICAL THERAPY, LTD
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 711 MADISON ST
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City | OAK PARK
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State | IL
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Zip | 60302-4410
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Country | US
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Telephone | 708-928-5500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10171
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City | CHICAGO
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State | IL
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Zip | 60610-0171
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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 | MANAGER
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Name | STEFANIE SHAW
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Credential |
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Telephone | 312-437-1129
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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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