Provider Demographics
NPI:1053908673
Name:NORTH SHORE BRAIN AND BODY INC
Entity type:Organization
Organization Name:NORTH SHORE BRAIN AND BODY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:224-688-7710
Mailing Address - Street 1:926 CLARK DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3115
Mailing Address - Country:US
Mailing Address - Phone:224-688-7710
Mailing Address - Fax:
Practice Address - Street 1:1590 S MILWAUKEE AVE STE 211
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3785
Practice Address - Country:US
Practice Address - Phone:224-688-7710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty