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General NPI Number Information
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NPI Number | 1902416720
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Entity Type | Organization
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Legal Business Name | EPICORE PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 1660 N LA SALLE DR APT 2708
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City | CHICAGO
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State | IL
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Zip | 60614-6021
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Country | US
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Telephone | 872-818-8895
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 N LA SALLE DR APT 2708
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City | CHICAGO
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State | IL
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Zip | 60614-6021
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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 | ADMIN
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Name | EDWARD C JONES
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Credential |
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Telephone | 314-452-0758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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