Provider Demographics
NPI:1629358189
Name:ORTHOPEDIC & MANUAL PT
Entity Type:Organization
Organization Name:ORTHOPEDIC & MANUAL PT
Other - Org Name:ORTHOPEDIC & MANUAL PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOATE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-523-5796
Mailing Address - Street 1:1355 N SANDBURG TER
Mailing Address - Street 2:#2008
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:742 N LA SALLE DR
Practice Address - Street 2:5TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8765
Practice Address - Country:US
Practice Address - Phone:312-523-5796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014259261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy