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General NPI Number Information
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NPI Number | 1740777879
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Entity Type | Organization
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Legal Business Name | GROWING TOGETHER PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 04/14/2018
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 2211 N ELSTON AVE STE 102
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City | CHICAGO
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State | IL
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Zip | 60614-2921
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Country | US
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Telephone | 312-358-1674
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Fax |
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Provider Business Mailing Address
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Address Line | 3143 LANDORE DR
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City | NAPERVILLE
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State | IL
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Zip | 60564-4100
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Country | US
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Telephone | 630-217-3590
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHANIE KOVACS
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Credential |
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Telephone | 630-217-3590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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