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General NPI Number Information
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NPI Number | 1558143727
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Entity Type | Organization
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Legal Business Name | GROUND UP REHAB PLLC
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1015 W WEBSTER AVE
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City | CHICAGO
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State | IL
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Zip | 60614-0518
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Country | US
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Telephone | 773-802-3229
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Fax |
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Provider Business Mailing Address
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Address Line | 313 W WOLF POINT PLZ UNIT 2002
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City | CHICAGO
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State | IL
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Zip | 60654-8908
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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 | CLINICIAN OWNER
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Name | DAVOR VASILJEVIC
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Credential |
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Telephone | 773-234-5715
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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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