Provider Demographics
NPI:1568175404
Name:BREVING PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:BREVING PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BREVING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:847-908-3936
Mailing Address - Street 1:1252 W ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3453
Mailing Address - Country:US
Mailing Address - Phone:773-383-2727
Mailing Address - Fax:847-250-2540
Practice Address - Street 1:1609 SHERMAN AVE STE 308
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5013
Practice Address - Country:US
Practice Address - Phone:847-908-3936
Practice Address - Fax:847-250-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty