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General NPI Number Information
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NPI Number | 1952773145
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Entity Type | Organization
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Legal Business Name | CHICAGO MANUAL THERAPY LLC
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 1401 W CARROLL AVE
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City | CHICAGO
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State | IL
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Zip | 60607-1105
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Country | US
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Telephone | 872-802-1268
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Fax |
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Provider Business Mailing Address
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Address Line | 500 S CLINTON ST APT 424
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City | CHICAGO
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State | IL
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Zip | 60607-4322
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Country | US
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Telephone | 260-348-5567
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST / FOUNDER
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Name | JOSHUA E MCFARREN
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Credential | PT
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Telephone | 260-348-5567
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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 | 070013597
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License Number State | IL
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