Provider Demographics
NPI:1861150070
Name:NOURISH PHYSICAL THERAPY & WELLNESS
Entity type:Organization
Organization Name:NOURISH PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT, NCS
Authorized Official - Phone:847-533-7844
Mailing Address - Street 1:6886 N TONTY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-1315
Mailing Address - Country:US
Mailing Address - Phone:847-533-7844
Mailing Address - Fax:
Practice Address - Street 1:6886 N TONTY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-1315
Practice Address - Country:US
Practice Address - Phone:847-533-7844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-04
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy