Provider Demographics
NPI:1225547045
Name:LINK PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:LINK PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:ACERON
Authorized Official - Last Name:BADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-868-8396
Mailing Address - Street 1:528 KEDZIE ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2306
Mailing Address - Country:US
Mailing Address - Phone:847-868-8396
Mailing Address - Fax:847-905-0218
Practice Address - Street 1:528 KEDZIE ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2306
Practice Address - Country:US
Practice Address - Phone:773-791-5969
Practice Address - Fax:847-905-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011033225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty