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General NPI Number Information
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NPI Number | 1962174631
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Entity Type | Organization
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Legal Business Name | SPECIALIZED PT PLLC
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 07/10/2022
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Provider Practice Location Address
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Address Line | 2000 N RACINE AVE UNIT 1000B
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City | CHICAGO
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State | IL
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Zip | 60614-4045
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Country | US
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Telephone | 773-835-1884
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Fax |
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Provider Business Mailing Address
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Address Line | 3838 N HAMILTON AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3918
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Country | US
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Telephone | 773-835-1884
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Fax | 773-672-7618
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MAUREEN MCCLAIN GEORGE
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Credential | PT
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Telephone | 773-835-1884
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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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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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