| NPI | 1548249337 |
|---|---|
| Former Legal Business Name | LAKESHORE SPORTS PHYSICAL THERAPY PC |
| Entity Type | Organization |
| Authorized Contact | ANGELA WILSON PENNISI President 773-665-9950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 060008615) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2025-03-19 |