Provider Demographics
NPI:1275706368
Name:PHYSICALLY PHIT
Entity Type:Organization
Organization Name:PHYSICALLY PHIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARGAVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-285-1090
Mailing Address - Street 1:2320 N DAMEN AVE STE 1R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3359
Mailing Address - Country:US
Mailing Address - Phone:773-489-0001
Mailing Address - Fax:773-489-0003
Practice Address - Street 1:2320 N DAMEN AVE STE 1R
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3359
Practice Address - Country:US
Practice Address - Phone:773-489-0001
Practice Address - Fax:773-489-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty