Provider Demographics
NPI:1255455986
Name:WEESHINE PEDIATRIC PHYSICAL THERAPY, LTD
Entity type:Organization
Organization Name:WEESHINE PEDIATRIC PHYSICAL THERAPY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRISTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-330-8025
Mailing Address - Street 1:1354 N MAPLEWOOD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2827
Mailing Address - Country:US
Mailing Address - Phone:773-330-8025
Mailing Address - Fax:773-256-9107
Practice Address - Street 1:1354 N MAPLEWOOD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2827
Practice Address - Country:US
Practice Address - Phone:773-330-8025
Practice Address - Fax:773-256-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty