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General NPI Number Information
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NPI Number | 1679873111
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Entity Type | Organization
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Legal Business Name | MONTGOMERY PLACE
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 5550 S SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60637-5051
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Country | US
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Telephone | 773-753-4100
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Fax | 773-752-0056
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Provider Business Mailing Address
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Address Line | 5550 S SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60637-5051
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Country | US
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Telephone | 773-753-4100
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Fax | 773-752-0056
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Authorized Official
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Title or Position | ADMINISTRATOR/DIRECTOR OF OPERATION
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Name | MARY FRANCES VON GOEBEN
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Credential | LNHA
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Telephone | 773-617-1447
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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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