Provider Demographics
NPI:1295071090
Name:JOURNEY PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:JOURNEY PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:224-766-6346
Mailing Address - Street 1:2754 N HAMPDEN CT
Mailing Address - Street 2:UNIT 805
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1651
Mailing Address - Country:US
Mailing Address - Phone:224-766-6346
Mailing Address - Fax:
Practice Address - Street 1:2250 W BELMONT AVE
Practice Address - Street 2:UNIT 1W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6561
Practice Address - Country:US
Practice Address - Phone:773-883-2337
Practice Address - Fax:773-883-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-25
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0171532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859043Medicare PIN
IL211585024Medicare PIN