Organization Name: | DPT SPORT PC |
NPI Number: | 1114350980 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTINE ANN KLODY (PRESIDENT/PHYSICAL THERAPIST) |
Mailing Address: | 6101 S County Line Rd Suite # 57 Burr Ridge |
State: | IL US |
Postal Code: | 605278132 |
Phone Number: | 3122867147 |
Fax Number: | |
NPI Enumeration Date: | 08/16/2013 |
NPI Last Update Date: | 06/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 070013512 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |