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General NPI Number Information
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NPI Number | 1780157438
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Entity Type | Organization
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Legal Business Name | INTEGRATED PHYSICAL THERAPY AND YOGA LLC
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Dates
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Enumeration Date | 01/05/2019
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Last Update Date | 01/05/2019
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Provider Practice Location Address
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Address Line | 1818 DEMPSTER ST
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City | EVANSTON
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State | IL
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Zip | 60202-1003
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Country | US
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Telephone | 224-935-3081
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 ISABELLA ST
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City | EVANSTON
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State | IL
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Zip | 60201-1622
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Country | US
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Telephone | 224-935-3081
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA ANNE PAULIN-LISTON
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Credential | PT
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Telephone | 224-935-3081
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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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