Provider Demographics
NPI:1467884007
Name:CHICAGO PHYSICAL THERAPY & REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:CHICAGO PHYSICAL THERAPY & REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:TATARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-726-1353
Mailing Address - Street 1:30 S MICHIGAN AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3211
Mailing Address - Country:US
Mailing Address - Phone:312-726-1353
Mailing Address - Fax:312-726-5238
Practice Address - Street 1:30 S MICHIGAN AVE STE 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3211
Practice Address - Country:US
Practice Address - Phone:312-726-1353
Practice Address - Fax:312-726-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty