Provider Demographics
NPI:1891387403
Name:INCHWORMS PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:INCHWORMS PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIFFHORN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:651-587-5454
Mailing Address - Street 1:1350 W DIVERSEY PKWY APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6764
Mailing Address - Country:US
Mailing Address - Phone:651-587-5454
Mailing Address - Fax:
Practice Address - Street 1:1350 W DIVERSEY PKWY APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6764
Practice Address - Country:US
Practice Address - Phone:651-587-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy