Provider Demographics
NPI:1538613674
Name:CATALYST PHYSIOTHERAPY, PERFORMANCE, & WELLNESS LLC
Entity type:Organization
Organization Name:CATALYST PHYSIOTHERAPY, PERFORMANCE, & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO - OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENHAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, GCS
Authorized Official - Phone:815-793-7550
Mailing Address - Street 1:710 E RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2250
Mailing Address - Country:US
Mailing Address - Phone:815-313-6333
Mailing Address - Fax:815-417-6921
Practice Address - Street 1:710 E RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548
Practice Address - Country:US
Practice Address - Phone:815-313-6333
Practice Address - Fax:815-417-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700103892251S0007X
IL0700200852251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1902911076Medicare PIN
IL1447684113Medicare PIN