Organization
FREE BODY PHYSICAL THERAPY PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARC GREGORY GUILLEN PT, DPT (OWNER, PHYSICAL THERAPIST)
(773) 599-3393
Entity
Organization
Contact information
Practice address
3132 W NORTH AVE, SUITE B, CHICAGO, IL 60647-8415
(773) 599-3393
Mailing address
5509 HARVARD TER, SKOKIE, IL 60077-2753
(773) 599-3393
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
070019810
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070019810
LICENSE NUMBER
IL
Enumeration date
11/11/2016
Last updated
01/06/2017
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