1316088651 NPI number — FOREST HILLS PHYSICAL THERAPY AND REHAB INC

Table of content: (NPI 1316088651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316088651 NPI number — FOREST HILLS PHYSICAL THERAPY AND REHAB INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOREST HILLS PHYSICAL THERAPY AND REHAB INC
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:
1316088651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3545 ROSE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60131-2068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-229-9828
Provider Business Mailing Address Fax Number:
708-422-0914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3545 ROSE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60131-2068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-229-9828
Provider Business Practice Location Address Fax Number:
708-422-0914
Provider Enumeration Date:
02/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
MASHKOOR
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
708-229-9828

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 132265800 . This is a "OWCP DEPT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2221297 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".