Provider Demographics
NPI:1588374771
Name:LINCOLN PARK PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:LINCOLN PARK PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENI
Authorized Official - Middle Name:
Authorized Official - Last Name:POULAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-715-1873
Mailing Address - Street 1:1108 W OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4320
Mailing Address - Country:US
Mailing Address - Phone:773-715-1873
Mailing Address - Fax:
Practice Address - Street 1:2911 N HALSTED ST STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8400
Practice Address - Country:US
Practice Address - Phone:773-715-1873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy