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General NPI Number Information
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NPI Number | 1932700770
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Entity Type | Organization
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Legal Business Name | BROADLEAF HEALTH AND WELLNESS
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 3245 GROVE AVE STE 205
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City | BERWYN
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State | IL
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Zip | 60402-3476
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Country | US
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Telephone | 773-947-4607
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Fax |
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Provider Business Mailing Address
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Address Line | 3245 GROVE AVE STE 205
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City | BERWYN
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State | IL
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Zip | 60402-3476
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Country | US
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Telephone | 773-947-4607
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Fax |
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Authorized Official
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Title or Position | REHAB PRACTITIONER
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Name | MARIA ESPEJO
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Credential | OT/CCCPA
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Telephone | 773-947-4607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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