Provider Demographics
NPI:1306114699
Name:TELOS THERAPY, LLC
Entity type:Organization
Organization Name:TELOS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEFANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SARELAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-404-1548
Mailing Address - Street 1:651 W WASHINGTON BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2137
Mailing Address - Country:US
Mailing Address - Phone:312-404-1548
Mailing Address - Fax:312-470-6550
Practice Address - Street 1:651 W WASHINGTON BLVD STE 305
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661
Practice Address - Country:US
Practice Address - Phone:312-880-9355
Practice Address - Fax:312-470-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty