Healthcare Provider Details

I. General information

NPI: 1679397442
Provider Name (Legal Business Name): COMMUNITY PHYSICAL THERAPY & ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 W EXECUTIVE DR STE 500
ADDISON IL
60101-5626
US

IV. Provider business mailing address

2171 W EXECUTIVE DR STE 500
ADDISON IL
60101-5626
US

V. Phone/Fax

Practice location:
  • Phone: 630-766-0505
  • Fax:
Mailing address:
  • Phone: 630-766-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CARLA HERNANDEZ
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential: PTA
Phone: 708-969-7919