Provider Demographics
NPI:1851419113
Name:ACCESS CENTER PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ACCESS CENTER PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:CHENOWETH
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:312-573-1441
Mailing Address - Street 1:211 E ONTARIO ST
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3468
Mailing Address - Country:US
Mailing Address - Phone:312-573-1441
Mailing Address - Fax:312-573-9929
Practice Address - Street 1:211 E ONTARIO ST
Practice Address - Street 2:SUITE 1450
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3468
Practice Address - Country:US
Practice Address - Phone:312-573-1441
Practice Address - Fax:312-573-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635145OtherBLUE CROSS BLUE SHIELD-IL
ILK20715Medicare ID - Type UnspecifiedMEDICARE CLINIC NUMBER