Organization
COAST PT & AQUATIC REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALDINE A MOHEN PT (DIRECTOR, CLINICAL OPERATIONS)
(917) 215-3784
Entity
Organization
Contact information
Practice address
2641 W HARRISON ST, COAST PT & AQUATIC REHAB @ QUEST, CHICAGO, IL 60612-3420
(917) 215-3784
Mailing address
39 E SCHILLER ST, UNIT 2E, CHICAGO, IL 60610-6162
(917) 215-3784
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
IL
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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