Provider Demographics
NPI:1639530371
Name:SOMMO LLC
Entity Type:Organization
Organization Name:SOMMO LLC
Other - Org Name:PROFORMANCE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT,ATC,CSCS
Authorized Official - Phone:773-957-6841
Mailing Address - Street 1:1824 JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1657
Mailing Address - Country:US
Mailing Address - Phone:847-581-6300
Mailing Address - Fax:847-657-0408
Practice Address - Street 1:1824 JOHNS DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-581-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013977261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy