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NPI Code Detail

MEDICARE: RUSTUM THERAPY, LLC

MEDICARE: RUSTUM 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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1588477319
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSTUM THERAPY, LLC
Provider Business Mailing Address
First Line : 4050 N MOZART ST
Second Line :
City : CHICAGO
State : IL
Zip : 60618-2707
Country : US
Telephone Number : 773-691-0086
Fax Number :
Provider Business Practice Location Address
First Line : 4941 N KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-5009
Country : US
Telephone Number : 773-691-0086
Fax Number :
Authorized Official
Title or Position : OWNER
Name : HAMID RUSTUM
Credential :
Telephone Number : 773-691-0086
Provider Enumeration Date : 01/27/2025
Last Update Date : 01/27/2025

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Directions to “RUSTUM THERAPY, LLC ” Practice Location

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