Provider Demographics
NPI:1952705154
Name:ABC4WELLNESS, LTD.
Entity Type:Organization
Organization Name:ABC4WELLNESS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRISTINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-560-1611
Mailing Address - Street 1:811 DAMICO DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1934
Mailing Address - Country:US
Mailing Address - Phone:708-560-1611
Mailing Address - Fax:
Practice Address - Street 1:811 DAMICO DR
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1934
Practice Address - Country:US
Practice Address - Phone:708-560-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015149261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy