Provider Demographics
NPI:1528622263
Name:PRECISION PERFORMANCE AND SPORTS MEDICINE
Entity type:Organization
Organization Name:PRECISION PERFORMANCE AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:312-620-0902
Mailing Address - Street 1:3017 N MANGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5217
Mailing Address - Country:US
Mailing Address - Phone:312-576-0199
Mailing Address - Fax:
Practice Address - Street 1:1 S NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4240
Practice Address - Country:US
Practice Address - Phone:312-620-0902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISION FITNESS TRAINING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-29
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy