Provider Demographics
NPI:1679845887
Name:HOLISTIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HOLISTIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:630-546-9565
Mailing Address - Street 1:3717 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3880
Mailing Address - Country:US
Mailing Address - Phone:630-546-9565
Mailing Address - Fax:708-529-0355
Practice Address - Street 1:3717 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3880
Practice Address - Country:US
Practice Address - Phone:630-546-9565
Practice Address - Fax:708-529-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016665261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy