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General NPI Number Information
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NPI Number | 1770873945
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Entity Type | Organization
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Legal Business Name | FUNCTION1ST PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 7421 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60634-2139
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Country | US
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Telephone | 847-370-5600
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Fax | 866-788-4922
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Provider Business Mailing Address
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Address Line | PO BOX 2433
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City | PALATINE
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State | IL
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Zip | 60078-2433
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Country | US
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Telephone | 847-370-5600
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Fax | 866-787-3422
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DESI 'AL' FLORES
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Credential | P.T.
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Telephone | 847-370-5600
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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 | 070011147
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License Number State | IL
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