Provider Demographics
NPI:1083733935
Name:JUDITH FLORENDO, PC
Entity Type:Organization
Organization Name:JUDITH FLORENDO, PC
Other - Org Name:FLORENDO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDEND
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORENDO
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:312-337-8840
Mailing Address - Street 1:600 N MCCLURG CT
Mailing Address - Street 2:A312
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3044
Mailing Address - Country:US
Mailing Address - Phone:312-337-8840
Mailing Address - Fax:312-337-9334
Practice Address - Street 1:600 N MCCLURG CT
Practice Address - Street 2:A312
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3044
Practice Address - Country:US
Practice Address - Phone:312-337-8840
Practice Address - Fax:312-337-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004706225100000X
IL070012388225100000X
IL070009984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633177OtherBLUECROSS BLUESHIELD
IL01633177OtherBLUECROSS BLUESHIELD