Organization
DIRECT ACCESS THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SIVA KUMAR MENON P.T. (PRESIDENT)
(708) 383-8705
Entity
Organization
Contact information
Practice address
101 N EUCLID AVE, UNIT #29, OAK PARK, IL 60301-1427
(708) 383-8705
Mailing address
101 N EUCLID AVE, UNIT #29, OAK PARK, IL 60301-1427
(708) 383-8705
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-008586
IL
261QP2000X
Physical Therapy Clinic/Center
070-008586
IL
Other
Enumeration date
05/03/2008
Last updated
05/03/2008
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