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General NPI Number Information
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NPI Number | 1679871453
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICAL THERAPY & SPINAL REHAB, CORP.
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 03/13/2011
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Provider Practice Location Address
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Address Line | 9849 GROSS POINT RD
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City | SKOKIE
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State | IL
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Zip | 60076-1145
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Country | US
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Telephone | 847-675-7025
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Fax | 847-675-7026
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Provider Business Mailing Address
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Address Line | 9849 GROSS POINT RD
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City | SKOKIE
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State | IL
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Zip | 60076-1145
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Country | US
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Telephone | 847-675-7025
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Fax | 847-675-7026
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Authorized Official
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Title or Position | OWNER
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Name | DR. JIN WOO LEE
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Credential |
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Telephone | 847-675-7025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038009729
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070016580
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License Number State | IL
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