Provider Demographics
NPI:1235710807
Name:ROSCOE VILLAGE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ROSCOE VILLAGE PHYSICAL THERAPY PLLC
Other - Org Name:WEST TOWN PHYSICAL THERAPY AT ROSCOE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:773-729-2551
Mailing Address - Street 1:1900 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9582
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9582
Practice Address - Country:US
Practice Address - Phone:773-729-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST TOWN PHYSICAL THERAPY LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-15
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy