Provider Demographics
NPI:1972264299
Name:CENTRE PHYSICAL THERAPY LINCOLN PARK LLC
Entity Type:Organization
Organization Name:CENTRE PHYSICAL THERAPY LINCOLN PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEGEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-210-9800
Mailing Address - Street 1:207 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1533
Mailing Address - Country:US
Mailing Address - Phone:708-210-9800
Mailing Address - Fax:
Practice Address - Street 1:2116 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4316
Practice Address - Country:US
Practice Address - Phone:708-210-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty