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General NPI Number Information
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NPI Number | 1497033971
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Entity Type | Organization
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Legal Business Name | SUPER THERAPY CLINIC LTD
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 4832 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60640-3704
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Country | US
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Telephone | 773-561-0778
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Fax | 773-561-0779
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Provider Business Mailing Address
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Address Line | 4832 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60640-3704
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Country | US
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Telephone | 773-561-0778
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Fax | 773-561-0779
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN J KIM
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Credential |
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Telephone | 708-602-4414
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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 | 2098795
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License Number State | IL
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