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General NPI Number Information
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NPI Number | 1679105142
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Entity Type | Organization
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Legal Business Name | EMERGE PHYSICAL THERAPY & WELLNESS PLLC
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 1962 N BISSELL ST UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60614-5015
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Country | US
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Telephone | 847-975-3616
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 N DEARBORN ST APT 1601
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City | CHICAGO
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State | IL
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Zip | 60610-2080
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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 | MANAGER
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Name | NICOLE F WODKA
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Credential | DPT
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Telephone | 847-975-3616
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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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