Provider Demographics
NPI:1194170241
Name:CHICAGO RIDGE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:CHICAGO RIDGE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:708-903-4105
Mailing Address - Street 1:10255 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1350
Mailing Address - Country:US
Mailing Address - Phone:708-903-4105
Mailing Address - Fax:
Practice Address - Street 1:10255 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1350
Practice Address - Country:US
Practice Address - Phone:708-903-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty