Provider Demographics
NPI:1831479542
Name:PEDIATRIC THERAPY NETWORK
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRISTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-278-0022
Mailing Address - Street 1:2506 N CLARK ST
Mailing Address - Street 2:#158
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1848
Mailing Address - Country:US
Mailing Address - Phone:312-278-0022
Mailing Address - Fax:888-975-3791
Practice Address - Street 1:2506 N CLARK ST
Practice Address - Street 2:#158
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1848
Practice Address - Country:US
Practice Address - Phone:312-278-0022
Practice Address - Fax:888-975-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011057225100000X
IL0700105892251P0200X
IL056003575225X00000X
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty