1184879538 NPI number — COMPLEX THERAPY, LTD

Table of content: (NPI 1184879538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184879538 NPI number — COMPLEX THERAPY, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLEX THERAPY, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184879538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 N HUBBARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALGONQUIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60102-2459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-439-5445
Provider Business Mailing Address Fax Number:
224-333-0589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 N HUBBARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALGONQUIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60102-2459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-439-5445
Provider Business Practice Location Address Fax Number:
224-333-0589
Provider Enumeration Date:
11/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TRYBA
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-439-5445

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  070.010895 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01627658 . This is a "BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com