NPIMap

Organization Active NPI

Free Body Physical Therapy Professional Corporation

  • Physical Therapy Clinic/Center
  • Chicago, IL
National Provider Identifier
1407398126
Registry record updated Jan 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
070019810 Issued in IL
Legal business name
FREE BODY PHYSICAL THERAPY PROFESSIONAL CORPORATION
Practice address
3132 W North Ave
Suite B
Chicago, IL 60647-8415
Phone
(773) 599-3393
NPI assigned
Nov 11, 2016
Last updated
Jan 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2017

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

Authorized official

Name
Dr. Marc Gregory Guillen, PT, DPTNPI 1578717773
Title
Owner, Physical Therapist
Phone
(773) 599-3393

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 070019810 IL Primary

Addresses

Primary practice location

3132 W North Ave
Suite B
Chicago, IL 60647-8415

Mailing address

5509 Harvard Ter
Skokie, IL 60077-2753
Phone (773) 599-3393

Other identifiers 1

IdentifierTypeStateIssuer
070019810OtherILLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170323002291 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5698050169 Receives reassigned benefits from 12 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1478822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483660800000",
    "number": "1407398126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5509 HARVARD TER",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600772753",
            "telephone_number": "773-599-3393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3132 W NORTH AVE",
            "address_2": "SUITE B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606478415",
            "telephone_number": "773-599-3393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREE BODY PHYSICAL THERAPY PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-11",
        "last_updated": "2017-01-06",
        "status": "A",
        "authorized_official_last_name": "GUILLEN",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "773-599-3393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070019810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "070019810",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.