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General NPI Number Information
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NPI Number | 1669172961
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Entity Type | Organization
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Legal Business Name | BERWYN PHYSICAL THERAPY LTD
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 6544 CERMAK RD UNIT 2
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City | BERWYN
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State | IL
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Zip | 60402-2324
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Country | US
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Telephone | 708-637-4273
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Fax | 773-634-8295
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Provider Business Mailing Address
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Address Line | PO BOX 10693
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City | CHICAGO
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State | IL
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Zip | 60610-0693
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Country | US
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Telephone | 708-637-4273
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Fax | 773-634-8295
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | STEFANIE SHAW
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Credential |
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Telephone | 312-437-1129
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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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