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General NPI Number Information
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NPI Number | 1700185741
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Entity Type | Organization
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Legal Business Name | HEALTHY BODY HEALTHY MIND
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 1029 W PARK AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2550
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Country | US
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Telephone | 847-722-8704
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Fax | 847-929-9568
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Provider Business Mailing Address
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Address Line | 1029 W PARK AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2550
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Country | US
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Telephone | 847-722-8704
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Fax | 847-929-9568
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DAVID FOO
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Credential | PT
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Telephone | 847-722-8704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198000668
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198000516
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070013796
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License Number State | IL
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