Healthcare Provider Details

I. General information

NPI: 1285731547
Provider Name (Legal Business Name): COMMUNITY PHYSICAL THERAPY & ASSOC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 W EXECUTIVE DR SUITE 450
ADDISON IL
60101-5625
US

IV. Provider business mailing address

2171 W EXECUTIVE DR SUITE 500
ADDISON IL
60101-5625
US

V. Phone/Fax

Practice location:
  • Phone: 630-282-5588
  • Fax: 630-282-5587
Mailing address:
  • Phone: 630-282-5588
  • Fax: 630-282-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01683361
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS/BLUE SHIELD

VIII. Authorized Official

Name: MR. ROBERT TRIPICCHIO
Title or Position: PRESIDENT
Credential: PT D.SC.
Phone: 630-766-0505