Organization
PT WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SARA BRIN KARP MAST OF PHYS THERAPY (PRESIDENT)
(773) 203-1314
Entity
Organization
Contact information
Practice address
1315 N BOSWORTH, CHICAGO, IL 60622
(773) 203-1314
(773) 395-2215
Mailing address
1315 N BOSWORTH, CHICAGO, IL 60622
(773) 203-1314
(773) 395-2215
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
070010529
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635329
BCBS
IL
Enumeration date
10/18/2006
Last updated
07/23/2008
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