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General NPI Number Information
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NPI Number | 1679845887
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Entity Type | Organization
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Legal Business Name | HOLISTIC PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 3717 N RAVENSWOOD AVE SUITE 213
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City | CHICAGO
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State | IL
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Zip | 60613-3880
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Country | US
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Telephone | 630-546-9565
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Fax | 708-529-0355
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Provider Business Mailing Address
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Address Line | 3717 N RAVENSWOOD AVE SUITE 213
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City | CHICAGO
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State | IL
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Zip | 60613-3880
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Country | US
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Telephone | 630-546-9565
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Fax | 708-529-0355
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Authorized Official
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Title or Position | OWNER
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Name | DR. LINDA SUE BUTTS
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Credential | DPT
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Telephone | 630-546-9565
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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 | 070016665
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License Number State | IL
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