Provider Demographics
NPI:1790079077
Name:BOUNDLESS HEALTH, LLC
Entity Type:Organization
Organization Name:BOUNDLESS HEALTH, LLC
Other - Org Name:BOUNDLESS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRELJE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:773-562-0907
Mailing Address - Street 1:516 N OGDEN AVE
Mailing Address - Street 2:#203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6421
Mailing Address - Country:US
Mailing Address - Phone:773-562-0907
Mailing Address - Fax:312-488-3651
Practice Address - Street 1:2929 N SOUTHPORT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6945
Practice Address - Country:US
Practice Address - Phone:312-566-8460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOUNDLESS HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700132932251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty