Provider Demographics
NPI:1669915674
Name:ANNA'S PEDIATRIC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ANNA'S PEDIATRIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:ELYSE
Authorized Official - Last Name:JESS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-930-9851
Mailing Address - Street 1:2120 W ARMITAGE AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4516
Mailing Address - Country:US
Mailing Address - Phone:630-930-9851
Mailing Address - Fax:872-806-0916
Practice Address - Street 1:2120 W ARMITAGE AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4516
Practice Address - Country:US
Practice Address - Phone:630-930-9851
Practice Address - Fax:872-806-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty