Provider Demographics
NPI:1679871453
Name:ADVANCED PHYSICAL THERAPY & SPINAL REHAB, CORP.
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY & SPINAL REHAB, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:WOO
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-675-7025
Mailing Address - Street 1:9849 GROSS POINT RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1145
Mailing Address - Country:US
Mailing Address - Phone:847-675-7025
Mailing Address - Fax:847-675-7026
Practice Address - Street 1:9849 GROSS POINT RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1145
Practice Address - Country:US
Practice Address - Phone:847-675-7025
Practice Address - Fax:847-675-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009729111N00000X
IL070016580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty