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NPI Code Detail

MEDICARE: PEGASUS PHYSICAL THERAPY LLC

MEDICARE: PEGASUS PHYSICAL THERAPY 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
12251X0800XOrthopedic Physical Therapist

General Provider Information

NPI Number : 1457771958
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEGASUS PHYSICAL THERAPY LLC
Provider Business Mailing Address
First Line : 25 E WASHINGTON ST STE 1735
Second Line :
City : CHICAGO
State : IL
Zip : 60602-1882
Country : US
Telephone Number : 312-259-5712
Fax Number :
Provider Business Practice Location Address
First Line : 25 E WASHINGTON ST STE 1735
Second Line :
City : CHICAGO
State : IL
Zip : 60602-1882
Country : US
Telephone Number : 312-259-5712
Fax Number : 312-235-6346
Authorized Official
Title or Position : PRESIDENT
Name : MR. SCOTT P JOHNSON
Credential : PT, MPT, OCS
Telephone Number : 312-259-5712
Provider Enumeration Date : 04/23/2014
Last Update Date : 04/05/2024

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Directions to “PEGASUS PHYSICAL THERAPY LLC ” Practice Location

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