MEDICARE: ENTROPY PHYSIOTHERAPY AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	40976785	IL

General Provider Information

NPI Number	:	1326385477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTROPY PHYSIOTHERAPY AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1925 N CLYBOURN AVE
Second Line	:	SUITE 302
City	:	CHICAGO
State	:	IL
Zip	:	60614-4946
Country	:	US
Telephone Number	:	773-747-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 N CLYBOURN AVE
Second Line	:	SUITE 302
City	:	CHICAGO
State	:	IL
Zip	:	60614-4946
Country	:	US
Telephone Number	:	773-747-4070
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST, CO-OWNER
Name	:	DR. SARAH J HAAG
Credential	:	PT, DPT, WCS
Telephone Number	:	773-747-4070

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	01/06/2015

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