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Organization
FORM PHYSICAL THERAPY, LLC
Active
Organization
FORM PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN ELAVIA DPT (OWNER)
(708) 497-4600
Entity
Organization
Contact information
Practice address
10356 ROOSEVELT RD, WESTCHESTER, IL 60154
(708) 497-4600
(708) 497-4601
Mailing address
10356 ROOSEVELT RD, WESTCHESTER, IL 60154
(708) 497-4600
(708) 497-4601
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
06/13/2022
Last updated
07/26/2023
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