Provider Demographics
NPI:1780058479
Name:LIVING BEYOND THERAPEUTICS
Entity type:Organization
Organization Name:LIVING BEYOND THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:YUNDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:YNGSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-898-4777
Mailing Address - Street 1:1921 RIDGE RD
Mailing Address - Street 2:PO BOX 980
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4614
Mailing Address - Country:US
Mailing Address - Phone:708-898-4777
Mailing Address - Fax:708-880-4202
Practice Address - Street 1:19806 KILKENNY AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-4415
Practice Address - Country:US
Practice Address - Phone:708-898-4777
Practice Address - Fax:708-880-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007427235Z00000X
IL070015213261QP2000X
IL056002536261QX0100X
IL070016737261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine