MEDICARE: BRIAN SO

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	225100000X	Physical Therapist	070-020486	IL

General Provider Information

NPI Number	:	1588086805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN SO

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4620 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4620
Country	:	US
Telephone Number	:	773-728-2690
Fax Number	:	773-728-2692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	03/13/2025

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Directions to “ BRIAN SO ” Practice Location

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