Provider Demographics
NPI:1992585095
Name:LEGACY PHYSICAL THERAPY AND WELLNESS PLLC
Entity type:Organization
Organization Name:LEGACY PHYSICAL THERAPY AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COWAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:630-235-4433
Mailing Address - Street 1:1018 FOREST VIEW CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2248
Mailing Address - Country:US
Mailing Address - Phone:630-235-4433
Mailing Address - Fax:
Practice Address - Street 1:2764 AURORA AVE STE 124
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1007
Practice Address - Country:US
Practice Address - Phone:630-235-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy