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General NPI Number Information
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NPI Number | 1801543236
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Entity Type | Organization
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Legal Business Name | OFFSEASON PHYSICAL THERAPY AND SPORTS PERFORMANCE
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Dates
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Enumeration Date | 03/06/2022
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Last Update Date | 03/06/2022
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Provider Practice Location Address
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Address Line | 1690 N ELSTON AVE UNIT 2
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City | CHICAGO
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State | IL
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Zip | 60642-1530
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Country | US
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Telephone | 708-421-9269
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Fax |
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Provider Business Mailing Address
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Address Line | 445 E ORIOLE AVE
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City | ELMHURST
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State | IL
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Zip | 60126-4107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | LOIS KETTERING
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Credential | PT, DPT, CSCS
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Telephone | 708-421-9269
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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 |
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License Number State |
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