Provider Demographics
NPI:1033638010
Name:DYNAMIC PHYSICAL THERAPY CHICAGO
Entity Type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-606-9196
Mailing Address - Street 1:4321 N HAZEL ST APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1476
Mailing Address - Country:US
Mailing Address - Phone:773-606-9196
Mailing Address - Fax:312-896-5993
Practice Address - Street 1:220 W HURON ST STE 2004
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3951
Practice Address - Country:US
Practice Address - Phone:312-778-6455
Practice Address - Fax:312-896-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1851514079OtherNPI