Provider Demographics
NPI:1083309819
Name:PHYSIO CHICAGO PLLC
Entity Type:Organization
Organization Name:PHYSIO CHICAGO PLLC
Other - Org Name:PHYSIO CHICAGO PHYSICAL THERAPY AND FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:773-726-9880
Mailing Address - Street 1:4323 W IRVING PARK RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2828
Mailing Address - Country:US
Mailing Address - Phone:773-930-3087
Mailing Address - Fax:
Practice Address - Street 1:4323 W IRVING PARK RD STE 1A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2828
Practice Address - Country:US
Practice Address - Phone:773-726-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty