MEDICARE: MIDWEST PHYSICAL THERAPY CTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621171	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1447395413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST PHYSICAL THERAPY CTR

Provider Business Mailing Address
First Line	:	1000 E STATE PKWY
Second Line	:	SUITE E
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173-4569
Country	:	US
Telephone Number	:	630-285-8007
Fax Number	:	630-285-8017

Provider Business Practice Location Address
First Line	:	1710 N RANDALL RD
Second Line	:	SUITE 230
City	:	ELGIN
State	:	IL
Zip	:	60123-9400
Country	:	US
Telephone Number	:	847-931-8575
Fax Number	:	847-931-8581

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	DEVINDER DEOL
Credential	:
Telephone Number	:	630-285-8007

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/10/2012

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Directions to “MIDWEST PHYSICAL THERAPY CTR ” Practice Location

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