MEDICARE: THERAPY ON KING, 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

General Provider Information

NPI Number	:	1326625708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY ON KING, LLC

Provider Business Mailing Address
First Line	:	205 E BUTTERFIELD RD STE 228
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-7200
Country	:	US
Telephone Number	:	773-232-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E 41ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3071
Country	:	US
Telephone Number	:	773-232-0333
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONATA GOLISZEK
Credential	:
Telephone Number	:	773-232-0333

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	03/24/2021

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Directions to “THERAPY ON KING, LLC ” Practice Location

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