NPIMap

Organization Active NPI

LSF PT LLC

  • Physical Therapy Clinic/Center
  • Chicago, IL
National Provider Identifier
1629347992
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
070005021 Issued in IL
Legal business name
LSF PT LLC
Practice address
1320 W Fullerton Ave
Chicago, IL 60614-2129
Phone
(773) 770-2419
NPI assigned
Dec 15, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Authorized official

Name
Ms. Sally R Fansler, PT
Title
Managing Partner
Phone
(773) 770-2419

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 070005021 IL Primary

Addresses

Primary practice location

1320 W Fullerton Ave
Chicago, IL 60614-2129

Mailing address

1320 W Fullerton Ave
Chicago, IL 60614-2129
Phone (773) 770-2419

Other names 1

  • Lakeshore Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120229000290 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5890953483 Receives reassigned benefits from 4 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

1320 W Fullerton Ave
Chicago, IL 60614
Phone (773) 770-2419

3101 N Greenview Ave
Chicago, IL 60657
Phone (773) 270-1898

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1323907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1629347992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606142129",
            "telephone_number": "773-770-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606142129",
            "telephone_number": "773-770-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LSF PT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-15",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "FANSLER",
        "authorized_official_first_name": "SALLY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "773-770-2419",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070005021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeshore Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 21, 2023; 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.