MEDICARE: LIBERTY PHYSICAL THERAPY CENTER

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		IL

General Provider Information

NPI Number	:	1669691440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY PHYSICAL THERAPY CENTER

Provider Business Mailing Address
First Line	:	4550 SOUTHWEST HWY
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-1842
Country	:	US
Telephone Number	:	708-222-8870
Fax Number	:	708-222-8871

Provider Business Practice Location Address
First Line	:	4550 SOUTHWEST HWY
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-1842
Country	:	US
Telephone Number	:	708-229-8688
Fax Number	:	708-229-8687

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. MOHAMED EL SAYED
Credential	:	P.T.
Telephone Number	:	708-222-8870

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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