Provider Demographics
NPI:1245942556
Name:EMPOWER ADVANCED THERAPY
Entity type:Organization
Organization Name:EMPOWER ADVANCED THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GAGLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-970-2592
Mailing Address - Street 1:407 E TERRA COTTA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3602
Mailing Address - Country:US
Mailing Address - Phone:847-766-0011
Mailing Address - Fax:847-999-6722
Practice Address - Street 1:407 E TERRA COTTA AVE STE E
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3602
Practice Address - Country:US
Practice Address - Phone:847-766-0011
Practice Address - Fax:847-999-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation