Provider Demographics
NPI:1003036344
Name:PHYSICAL THERAPY CLINIC OF CHICAGO, P.C.
Entity type:Organization
Organization Name:PHYSICAL THERAPY CLINIC OF CHICAGO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAROSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-237-7827
Mailing Address - Street 1:6135 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5165
Mailing Address - Country:US
Mailing Address - Phone:773-237-7827
Mailing Address - Fax:773-237-7826
Practice Address - Street 1:6135 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5165
Practice Address - Country:US
Practice Address - Phone:773-237-7827
Practice Address - Fax:773-237-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633218OtherBLUECROSS BLUE SHIELD OF
IL01633218OtherBLUECROSS BLUE SHIELD OF