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General NPI Number Information
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NPI Number | 1659942183
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Entity Type | Organization
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Legal Business Name | -
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 2972 SHAMROCK CIR
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City | ELGIN
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State | IL
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Zip | 60124-4354
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Country | US
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Telephone | 224-465-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 2972 SHAMROCK CIR
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City | ELGIN
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State | IL
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Zip | 60124-4354
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Country | US
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Telephone | 224-465-1479
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD W EADEN
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Credential | MPT
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Telephone | 224-465-1479
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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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