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General NPI Number Information
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NPI Number | 1629358189
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC & MANUAL PT
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Dates
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Enumeration Date | 08/27/2011
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Last Update Date | 08/27/2011
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Provider Practice Location Address
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Address Line | 742 N LA SALLE DR 5TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60654-8765
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Country | US
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Telephone | 312-523-5796
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 N SANDBURG TER #2008
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City | CHICAGO
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State | IL
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Zip | 60610-2074
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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 | PRESIDENT
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Name | KATHRYN CHOATE
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Credential | PT
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Telephone | 312-523-5796
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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 | 070014259
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License Number State | IL
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