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General NPI Number Information
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NPI Number | 1639966211
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Entity Type | Organization
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Legal Business Name | FLEX FORWARD PHYSICAL THERAPY & WELLNESS LLC
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 1033 PROGRESS DR
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1672
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Country | US
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Telephone | 224-757-0099
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Fax | 224-223-8008
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Provider Business Mailing Address
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Address Line | 1916 HAZELWOOD DR
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City | LINDENHURST
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State | IL
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Zip | 60046-7019
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Country | US
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Telephone | 920-904-3634
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACOB PAUL GIESE
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Credential | PT DPT
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Telephone | 920-904-3634
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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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