Organization
ATHLETIC EDGE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL L GRAY (CEO)
(312) 617-5949
Entity
Organization
Contact information
Practice address
1319 S MICHIGAN AVE, CHICAGO, IL 60605-2601
(312) 617-5949
(312) 447-0036
Mailing address
1319 S MICHIGAN AVE, CHICAGO, IL 60605-2601
(312) 617-5949
(312) 447-0036
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070015130
IL
261QP2000X
Physical Therapy Clinic/Center
Primary
070015130
IL
Other
Enumeration date
03/02/2011
Last updated
06/06/2011
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