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General NPI Number Information
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NPI Number | 1437972643
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Entity Type | Organization
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Legal Business Name | NICHE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 137 N OAK PARK AVE STE 103
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City | OAK PARK
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State | IL
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Zip | 60301-1336
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Country | US
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Telephone | 847-858-7767
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Fax |
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Provider Business Mailing Address
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Address Line | 137 N OAK PARK AVE STE 103
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City | OAK PARK
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State | IL
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Zip | 60301-1336
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Country | US
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Telephone | 847-858-7767
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENDALL LYNCH
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Credential | PT, DPT, OCS
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Telephone | 847-858-7767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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