South Loop Pediatric Therapy LLC

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

070.013558 Issued in IL

Legal business name

SOUTH LOOP PEDIATRIC THERAPY LLC

Practice address

1515 S Prairie Ave
Unit 603
Chicago, IL 60605-3043

Phone

(773) 733-1695

Fax

(773) 435-6595

NPI assigned

Oct 23, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jana Marlene Susie, P.T.NPI 1184748220

Title

Physical Therapist

Phone

(773) 733-1695

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jana Marlene Susie, MSPT

  • Pediatric Physical Therapist
  • Winnetka, IL
  • NPI 1184748220

  Pediatrics

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256256000000",
    "number": "1356677462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 S PRAIRIE AVE",
            "address_2": "UNIT 603",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053043",
            "telephone_number": "773-733-1695",
            "fax_number": "773-435-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 S PRAIRIE AVE",
            "address_2": "UNIT 603",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053043",
            "telephone_number": "773-733-1695",
            "fax_number": "773-435-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LOOP PEDIATRIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-10-23",
        "status": "A",
        "authorized_official_last_name": "SUSIE",
        "authorized_official_first_name": "JANA",
        "authorized_official_middle_name": "MARLENE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "773-733-1695",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "IL",
            "license": "070.013558",
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IL",
            "license": "070.013558",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• South Loop Skilled Nursing Facility LLC
• South Loop Urgent Care, LLC
• South Michigan Ave Investments LLC

• Pediatric Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.