Organization
SOUTH LOOP PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANA MARLENE SUSIE P.T. (PHYSICAL THERAPIST)
(773) 733-1695
Entity
Organization
Contact information
Practice address
1515 S PRAIRIE AVE, UNIT 603, CHICAGO, IL 60605-3043
(773) 733-1695
(773) 435-6595
Mailing address
1515 S PRAIRIE AVE, UNIT 603, CHICAGO, IL 60605-3043
(773) 733-1695
(773) 435-6595
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
070.013558
IL
252Y00000X
Early Intervention Provider Agency
070.013558
IL
Other
Enumeration date
10/23/2009
Last updated
10/23/2009
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