Provider Demographics
NPI:1649930108
Name:LUX CONCIERGE PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:LUX CONCIERGE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-987-8554
Mailing Address - Street 1:3161 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4508
Mailing Address - Country:US
Mailing Address - Phone:847-987-5854
Mailing Address - Fax:
Practice Address - Street 1:3161 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4508
Practice Address - Country:US
Practice Address - Phone:847-220-4268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health