Healthcare Provider Details

I. General information

NPI: 1679019376
Provider Name (Legal Business Name): PHYSICAL THERAPY FOCUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 W REPUBLIC DR
ADDISON IL
60101-3133
US

IV. Provider business mailing address

467 YARDLEY DR
CAROL STREAM IL
60188-3979
US

V. Phone/Fax

Practice location:
  • Phone: 630-802-4897
  • Fax:
Mailing address:
  • Phone: 630-802-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070016010
License Number StateIL

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KARLA DUDA
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 630-802-4897