Provider Demographics
NPI:1467147223
Name:PELVIC FLOOR REHAB LLC
Entity Type:Organization
Organization Name:PELVIC FLOOR REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EVELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-414-2822
Mailing Address - Street 1:5256 W WINNEMAC AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2218
Mailing Address - Country:US
Mailing Address - Phone:773-414-2822
Mailing Address - Fax:
Practice Address - Street 1:5256 W WINNEMAC AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2218
Practice Address - Country:US
Practice Address - Phone:773-414-2822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty