Provider Demographics
NPI:1497383673
Name:SPRY PHYSICAL THERAPY AND GERIATRIC WELLNESS, PLLC
Entity Type:Organization
Organization Name:SPRY PHYSICAL THERAPY AND GERIATRIC WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER OF PLLC
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:NORDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-735-2356
Mailing Address - Street 1:410 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-3634
Mailing Address - Country:US
Mailing Address - Phone:815-735-2356
Mailing Address - Fax:
Practice Address - Street 1:1028 LASALLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-6135
Practice Address - Country:US
Practice Address - Phone:815-735-2356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty