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Organization

JESSE BROWN VA MEDICAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SUBHADRA S VUNDAVILLI PT (PHYSICAL THERAPIST)
(312) 569-6397
Entity
Organization

Contact information

Practice address
820 S DAMEN, CHICAGO, IL 60612
(312) 569-6397
Mailing address
476 ALLES ST, DES PLAINES, IL 60016-7871
(708) 539-8119

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
161639
NPI ENUMERATOR NUMBER
IL
Enumeration date
06/09/2006
Last updated
08/22/2020
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