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General NPI Number Information
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NPI Number | 1710213293
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Entity Type | Organization
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Legal Business Name | AVANTE THERAPY SERVICES, INC
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 3912 W. 56TH PLACE
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City | CHICAGO
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State | IL
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Zip | 60629
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Country | US
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Telephone | 773-742-7137
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Fax | 773-581-1041
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Provider Business Mailing Address
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Address Line | P.O. BOX 388630
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City | CHICAGO
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State | IL
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Zip | 60638
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Country | US
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Telephone | 773-742-7137
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Fax | 773-581-1041
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Authorized Official
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Title or Position | SUPERVISOR P.T
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Name | SANDRA M. SALINAS
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Credential | P.T.
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Telephone | 773-742-7137
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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 | 070011371
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License Number State | IL
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