Provider Demographics
NPI:1043775844
Name:EXEMPLAR PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:EXEMPLAR PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-516-4146
Mailing Address - Street 1:1830 W FOSTER AVE UNIT CW
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1087
Mailing Address - Country:US
Mailing Address - Phone:773-516-4146
Mailing Address - Fax:773-961-7922
Practice Address - Street 1:1830 W FOSTER AVE STE CW
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1087
Practice Address - Country:US
Practice Address - Phone:773-516-4146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty