Organization
THERAPY YOGA GYMNASTICS ROCKS LLC
Active
Other names
TYGR
Organization subpart
No
Provider details
NPI number
Authorized official
DALA AAVIK LUCAS OTR/L (MANAGER)
(847) 414-1057
Entity
Organization
Contact information
Practice address
1845 RAYMOND DR, NORTHBROOK, IL 60062-6712
(847) 414-1057
Mailing address
3344 BELLWOOD LN, GLENVIEW, IL 60026-1528
(773) 878-1901
(773) 572-4886
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056.001897
IL
Other
Enumeration date
07/26/2010
Last updated
10/22/2011
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