Provider Demographics
NPI:1841600673
Name:PERFORM PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PERFORM PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-251-9491
Mailing Address - Street 1:7023 WILLOW SPRINGS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4841
Mailing Address - Country:US
Mailing Address - Phone:708-937-9249
Mailing Address - Fax:
Practice Address - Street 1:7023 WILLOW SPRINGS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-4841
Practice Address - Country:US
Practice Address - Phone:708-937-9249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-008575261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy