Provider Demographics
NPI:1104268648
Name:MARIE LOURDES PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:MARIE LOURDES PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:L
Authorized Official - Last Name:IPAPO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-895-7599
Mailing Address - Street 1:3355 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3602
Mailing Address - Country:US
Mailing Address - Phone:773-895-7599
Mailing Address - Fax:773-930-3131
Practice Address - Street 1:3355 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3602
Practice Address - Country:US
Practice Address - Phone:773-895-7599
Practice Address - Fax:773-930-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy