1649318833 NPI number — PHYSICAL THERAPY REHAB OF ILLINOIS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649318833 NPI number — PHYSICAL THERAPY REHAB OF ILLINOIS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY REHAB OF ILLINOIS 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:
1649318833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1S132 SUMMIT AVE
Provider Second Line Business Mailing Address:
STE. #108
Provider Business Mailing Address City Name:
OAKBROOK TERRACE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-261-0727
Provider Business Mailing Address Fax Number:
630-261-0716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E BUTTERFIELD RD
Provider Second Line Business Practice Location Address:
STE. #154
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60126-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-639-1153
Provider Business Practice Location Address Fax Number:
630-261-0716
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOHAMED
Authorized Official First Name:
HOSSAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-639-1153

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070-007491 , 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: 02232534 . This is a "BCBS OF IL PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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