Provider Demographics
NPI:1578665857
Name:VONNA KAROGHLANIAN PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:VONNA KAROGHLANIAN PHYSICAL THERAPY PC
Other - Org Name:VK PHYSICAL THERAPY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VONNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KAROGHLANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-283-9800
Mailing Address - Street 1:4849 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 405A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2169
Mailing Address - Country:US
Mailing Address - Phone:773-283-9800
Mailing Address - Fax:
Practice Address - Street 1:4849 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 405A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2169
Practice Address - Country:US
Practice Address - Phone:773-283-9800
Practice Address - Fax:773-283-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207986Medicare ID - Type Unspecified