1295380707 NPI number — RECOVERRX PHYSICAL THERAPY, LLC

Table of content: (NPI 1295380707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295380707 NPI number — RECOVERRX PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERRX PHYSICAL THERAPY, LLC
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:
1295380707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17W775 BUTTERFIELD RD STE 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKBROOK TERRACE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-4535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
331-253-2426
Provider Business Mailing Address Fax Number:
833-506-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17W775 BUTTERFIELD RD STE 128
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKBROOK TERRACE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60181-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
331-253-2426
Provider Business Practice Location Address Fax Number:
833-506-3220
Provider Enumeration Date:
08/02/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GREENWELL
Authorized Official First Name:
LUCAS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
331-253-2426

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1396093142 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629402706 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1942948278 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1295380707 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1851801849 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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