Provider Demographics
NPI:1710917158
Name:LIFESTYLE PHYSICAL THERAPY & BALANCE CENTER, PLLC
Entity Type:Organization
Organization Name:LIFESTYLE PHYSICAL THERAPY & BALANCE CENTER, PLLC
Other - Org Name:LIFESTYLE PHYSICAL THERAPY & BALANCE CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEHRER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:773-525-5200
Mailing Address - Street 1:1 E ERIE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4741
Mailing Address - Country:US
Mailing Address - Phone:773-525-5200
Mailing Address - Fax:773-525-5276
Practice Address - Street 1:3130 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3117
Practice Address - Country:US
Practice Address - Phone:773-525-5200
Practice Address - Fax:773-525-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014070225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID