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NPI Code Detail

MEDICARE: LIBERTY THERAPY INC

MEDICARE: LIBERTY THERAPY INC
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
1252Y00000XEarly Intervention Provider Agency

General Provider Information

NPI Number : 1548627045
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY THERAPY INC
Provider Business Mailing Address
First Line : PO BOX 480134
Second Line :
City : NILES
State : IL
Zip : 60714-0134
Country : US
Telephone Number : 773-506-9960
Fax Number :
Provider Business Practice Location Address
First Line : 5509 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1405
Country : US
Telephone Number : 773-506-9960
Fax Number :
Authorized Official
Title or Position : VICE-PRESIDENT
Name : JOHN ESCOBAR
Credential :
Telephone Number : 773-474-6158
Provider Enumeration Date : 01/28/2016
Last Update Date : 01/28/2016

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Directions to “LIBERTY THERAPY INC ” Practice Location

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