Provider Demographics
NPI:1487226312
Name:ADVANCE CORE PHYSICAL THERAPY AND WELLNESS PLLC
Entity type:Organization
Organization Name:ADVANCE CORE PHYSICAL THERAPY AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-400-4764
Mailing Address - Street 1:2500 WINDSOR MALL APT 3E
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3639
Mailing Address - Country:US
Mailing Address - Phone:646-400-4764
Mailing Address - Fax:
Practice Address - Street 1:5300 N LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-8035
Practice Address - Country:US
Practice Address - Phone:646-400-4764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty