Provider Demographics
NPI:1639966211
Name:FLEX FORWARD PHYSICAL THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:FLEX FORWARD PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GIESE
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:920-904-3634
Mailing Address - Street 1:1916 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7019
Mailing Address - Country:US
Mailing Address - Phone:920-904-3634
Mailing Address - Fax:
Practice Address - Street 1:1033 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1672
Practice Address - Country:US
Practice Address - Phone:224-757-0099
Practice Address - Fax:224-223-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty