Provider Demographics
NPI:1932585635
Name:LOVING STRIDES THERAPY, P.C.
Entity Type:Organization
Organization Name:LOVING STRIDES THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PAKENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:630-878-8114
Mailing Address - Street 1:2121 IROQUOIS LN
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4589
Mailing Address - Country:US
Mailing Address - Phone:630-878-8114
Mailing Address - Fax:630-230-5068
Practice Address - Street 1:2121 IROQUOIS LN
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-4589
Practice Address - Country:US
Practice Address - Phone:630-878-8114
Practice Address - Fax:630-230-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010672251E00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1194854919OtherPHYSICAL THERAPY