=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831968916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIED HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2023
-----------------------------------------------------
Last Update Date | 02/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6127 S UNIVERSITY AVE # 1268
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60637-5894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-875-1715
-----------------------------------------------------
Fax | 872-702-6451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1507 E 53RD ST # 232
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60615-4573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-875-1715
-----------------------------------------------------
Fax | 872-702-6451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | LAURIE LYNN WEBB
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 773-875-1715
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------