MEDICARE: LIFESTYLE PHYSICAL THERAPY & BALANCE CENTER, PLLC

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
2	225100000X	Physical Therapist	070014070	IL

General Provider Information

NPI Number	:	1710917158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE PHYSICAL THERAPY & BALANCE CENTER, PLLC

Provider Business Mailing Address
First Line	:	1 E ERIE ST STE 220
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4741
Country	:	US
Telephone Number	:	773-525-5200
Fax Number	:	773-525-5276

Provider Business Practice Location Address
First Line	:	3130 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3117
Country	:	US
Telephone Number	:	773-525-5200
Fax Number	:	773-525-5276

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MICHELE A KEHRER
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	773-525-5200

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	06/28/2022

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