=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851419113
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESS CENTER PHYSICAL THERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 01/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 E ONTARIO ST SUITE 1450
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-3468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-573-1441
-----------------------------------------------------
Fax | 312-573-9929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 E ONTARIO ST SUITE 1450
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-3468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-573-1441
-----------------------------------------------------
Fax | 312-573-9929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. AUDREY KIM CHENOWETH
-----------------------------------------------------
Credential | MSPT
-----------------------------------------------------
Telephone | 312-573-1441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070011361
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------