Provider Demographics
NPI:1669172961
Name:BERWYN PHYSICAL THERAPY LTD
Entity type:Organization
Organization Name:BERWYN PHYSICAL THERAPY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-437-1129
Mailing Address - Street 1:PO BOX 10693
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-0693
Mailing Address - Country:US
Mailing Address - Phone:708-637-4273
Mailing Address - Fax:773-634-8295
Practice Address - Street 1:6544 CERMAK RD UNIT 2
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2324
Practice Address - Country:US
Practice Address - Phone:708-637-4273
Practice Address - Fax:773-634-8295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy