Provider Demographics
NPI:1932625241
Name:CORE DYNAMICS THERAPY
Entity Type:Organization
Organization Name:CORE DYNAMICS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELBA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-532-4889
Mailing Address - Street 1:574 E THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3238
Mailing Address - Country:US
Mailing Address - Phone:847-532-4889
Mailing Address - Fax:
Practice Address - Street 1:574 E THORNWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3238
Practice Address - Country:US
Practice Address - Phone:847-532-4889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy