=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891221685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESCULPT PHYSICAL THERAPY AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2017
-----------------------------------------------------
Last Update Date | 02/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1895 CLAVEY RD
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60035-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-370-1525
-----------------------------------------------------
Fax | 847-810-0046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1895 CLAVEY RD
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60035-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-370-1525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CATHERIYA CURRAN
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 847-370-1525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070021475
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------