Provider Demographics
NPI:1538893367
Name:FINE LINE PHYSIO PC
Entity type:Organization
Organization Name:FINE LINE PHYSIO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IOANNIS
Authorized Official - Middle Name:DIMITRIOS
Authorized Official - Last Name:ANASTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-612-3339
Mailing Address - Street 1:713 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4764
Mailing Address - Country:US
Mailing Address - Phone:708-612-3339
Mailing Address - Fax:
Practice Address - Street 1:713 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4764
Practice Address - Country:US
Practice Address - Phone:708-612-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty