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General NPI Number Information
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NPI Number | 1760952626
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Entity Type | Organization
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Legal Business Name | PREP PERFORMANCE CENTER, LLC
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 3066 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-8008
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Country | US
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Telephone | 773-609-1847
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Fax | 312-637-6435
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Provider Business Mailing Address
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Address Line | 3066 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-8008
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Country | US
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Telephone | 773-609-1847
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Fax | 312-637-6435
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Authorized Official
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Title or Position | FOUNDER
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Name | MARY CATHERINE CASEY
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Credential | DPT
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Telephone | 773-844-0240
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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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