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General NPI Number Information
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NPI Number | 1538893367
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Entity Type | Organization
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Legal Business Name | FINE LINE PHYSIO PC
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Dates
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Enumeration Date | 07/16/2022
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 713 W DEVON AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-4764
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Country | US
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Telephone | 708-612-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 713 W DEVON AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-4764
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Country | US
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Telephone | 708-612-3339
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IOANNIS DIMITRIOS ANASTOS
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Credential | DPT
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Telephone | 708-612-3339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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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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