Provider Demographics
NPI:1407692353
Name:FOUNDATION PHYSICAL THERAPY
Entity type:Organization
Organization Name:FOUNDATION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:216-258-6744
Mailing Address - Street 1:1852 N BISSELL ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5013
Mailing Address - Country:US
Mailing Address - Phone:162-586-7442
Mailing Address - Fax:
Practice Address - Street 1:3834 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3218
Practice Address - Country:US
Practice Address - Phone:216-258-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty