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Organization
PHYSICAL THERAPY CLINIC OF CHICAGO, P.C.
Active
Organization
PHYSICAL THERAPY CLINIC OF CHICAGO, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAROSLAW PRUS P.T. (PRESIDENT)
(773) 237-7827
Entity
Organization
Contact information
Practice address
6135 W BELMONT AVE, CHICAGO, IL 60634-5165
(773) 237-7827
(773) 237-7826
Mailing address
6135 W BELMONT AVE, CHICAGO, IL 60634-5165
(773) 237-7827
(773) 237-7826
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633218
BLUECROSS BLUE SHIELD OF
IL
Enumeration date
04/27/2007
Last updated
08/22/2020
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