Provider Demographics
NPI:1881007391
Name:JOURNEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JOURNEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:774-883-2337
Mailing Address - Street 1:2250 W BELMONT AVE
Mailing Address - Street 2:1W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6561
Mailing Address - Country:US
Mailing Address - Phone:773-883-2337
Mailing Address - Fax:773-883-2336
Practice Address - Street 1:6663 W HOWARD ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3305
Practice Address - Country:US
Practice Address - Phone:773-883-2337
Practice Address - Fax:773-883-2336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEY PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty