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Organization
PREMIER PHYSICAL THERAPY PC
Active
Organization
PREMIER PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL NICOLE VAUGHN (CREDENTIALING SPECIALIST)
(630) 920-4670
Entity
Organization
Contact information
Practice address
3900 W 95TH ST, EVERGREEN PARK, IL 60805
(630) 920-4670
(630) 920-4687
Mailing address
570 VILLAGE CENTER DR STE 205, BURR RIDGE, IL 60527-4526
(630) 920-4670
(630) 920-4687
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070007675
IL
Other
Enumeration date
01/03/2006
Last updated
09/17/2024
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