Basic Information
| Provider Information | |||||||||
| NPI: | 1720554520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BGSD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 W VAN BUREN ST STE 100-107 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606073523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777091090 | ||||||||
| FaxNumber: | 8662213400 | ||||||||
| Practice Location | |||||||||
| Address1: | 9909 MIRA MESA BLVD STE 260 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921311064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777091090 | ||||||||
| FaxNumber: | 8662213400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2018 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | OURY | ||||||||
| AuthorizedOfficialFirstName: | APRIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8777091090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.