Provider Demographics
NPI:1871211607
Name:606 PHYSIO LLC
Entity type:Organization
Organization Name:606 PHYSIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROMPETER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-217-2550
Mailing Address - Street 1:2852 S LOWE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2511
Mailing Address - Country:US
Mailing Address - Phone:312-529-8187
Mailing Address - Fax:
Practice Address - Street 1:2852 S LOWE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2511
Practice Address - Country:US
Practice Address - Phone:312-529-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy