Provider Demographics
NPI:1093132771
Name:FLOURISH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FLOURISH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:847-736-8357
Mailing Address - Street 1:3524 N OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6024
Mailing Address - Country:US
Mailing Address - Phone:847-736-8357
Mailing Address - Fax:773-348-7774
Practice Address - Street 1:3717 N RAVENSWOOD AVE
Practice Address - Street 2:STE #213
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3880
Practice Address - Country:US
Practice Address - Phone:847-736-8357
Practice Address - Fax:773-348-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011324261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy