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General NPI Number Information
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NPI Number | 1699471136
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Entity Type | Organization
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Legal Business Name | GROUND FLOOR PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 4711 N BROADWAY ST STE 103
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City | CHICAGO
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State | IL
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Zip | 60640-4908
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Country | US
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Telephone | 312-344-3559
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Fax | 312-778-6529
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Provider Business Mailing Address
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Address Line | 4711 N BROADWAY ST STE 103
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City | CHICAGO
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State | IL
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Zip | 60640-4908
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Country | US
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Telephone | 312-344-3559
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Fax | 312-778-6529
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Authorized Official
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Title or Position | OWNER
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Name | ARIEL WYNNE
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Credential | PT, DPT
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Telephone | 312-344-3559
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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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