Healthcare Provider Details

I. General information

NPI: 1184879538
Provider Name (Legal Business Name): COMPLEX THERAPY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N HUBBARD ST
ALGONQUIN IL
60102-2459
US

IV. Provider business mailing address

105 N HUBBARD ST
ALGONQUIN IL
60102-2459
US

V. Phone/Fax

Practice location:
  • Phone: 630-439-5445
  • Fax: 224-333-0589
Mailing address:
  • Phone: 630-439-5445
  • Fax: 224-333-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070.010895
License Number StateIL

VIII. Authorized Official

Name: ROBERT TRYBA
Title or Position: PRESIDENT
Credential: PT
Phone: 630-439-5445