Provider Demographics
NPI:1679105142
Name:EMERGE PHYSICAL THERAPY & WELLNESS PLLC
Entity type:Organization
Organization Name:EMERGE PHYSICAL THERAPY & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WODKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:847-975-3616
Mailing Address - Street 1:1330 N DEARBORN ST APT 1601
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1962 N BISSELL ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5015
Practice Address - Country:US
Practice Address - Phone:847-975-3616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty