NPIMap

Organization Active NPI

Lakeshore Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Libertyville, IL
National Provider Identifier
1629363064
Registry record updated Jun 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
LAKESHORE PHYSICAL THERAPY, LLC
Practice address
712 S Milwaukee Ave
Lower Level
Libertyville, IL 60048-3279
Phone
(847) 362-1848
Fax
(847) 362-3351
NPI assigned
Jun 14, 2011
Last updated
Jun 17, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
LAKE COUNTY NEUROSURGERY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2011

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

Authorized official

Name
Jonathan S Citow, MDNPI 1093703571
Title
Owner
Phone
(847) 362-1848

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

712 S Milwaukee Ave
Lower Level
Libertyville, IL 60048-3279

Mailing address

712 S Milwaukee Ave
Lower Level
Libertyville, IL 60048-3279
Phone (847) 362-1848

National Provider Directory

National Provider Directory
Part of
American Center for Spine Neurosurgery LLC

Locations

712 S Milwaukee Ave
Lowr
Libertyville, IL 60048
Phone (847) 362-1848

Practitioners & affiliated clinicians

Practitioners 1

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": "1308009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308268800000",
    "number": "1629363064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 S MILWAUKEE AVE",
            "address_2": "LOWER LEVEL",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483279",
            "telephone_number": "847-362-1848",
            "fax_number": "847-362-3351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 S MILWAUKEE AVE",
            "address_2": "LOWER LEVEL",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483279",
            "telephone_number": "847-362-1848",
            "fax_number": "847-362-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE COUNTY NEUROSURGERY, LLC",
        "enumeration_date": "2011-06-14",
        "last_updated": "2011-06-17",
        "status": "A",
        "authorized_official_last_name": "CITOW",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-362-1848",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2011; 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.