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General NPI Number Information
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NPI Number | 1912954074
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Entity Type | Organization
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Legal Business Name | PERFORMANCE PHYSICAL THERAPY OF BRIDGEVIEW
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 4807 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2501
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Country | US
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Telephone | 708-599-1983
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Fax | 708-599-7420
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Provider Business Mailing Address
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Address Line | 4807 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2501
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Country | US
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Telephone | 708-599-1983
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Fax | 708-599-7420
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Authorized Official
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Title or Position | PARTNER/MANAGER
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Name | JAMES JUDGE
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Credential | P.T.
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Telephone | 708-599-1983
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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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