1538613674 NPI number — CATALYST PHYSIOTHERAPY, PERFORMANCE, & WELLNESS LLC

Table of content: (NPI 1538613674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538613674 NPI number — CATALYST PHYSIOTHERAPY, PERFORMANCE, & WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATALYST PHYSIOTHERAPY, PERFORMANCE, & WELLNESS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538613674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 E RAILROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDWICH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60548-2250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-313-6333
Provider Business Mailing Address Fax Number:
815-417-6921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 E RAILROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDWICH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-313-6333
Provider Business Practice Location Address Fax Number:
815-417-6921
Provider Enumeration Date:
08/05/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREENHAGEN
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CO - OWNER PHYSICAL THERAPIST
Authorized Official Telephone Number:
815-793-7550

Provider Taxonomy Codes

  • Taxonomy code: 2251G0304X , with the licence number:  070020085 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251S0007X , with the licence number: 070010389 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)