Healthcare Provider Details

I. General information

NPI: 1144939281
Provider Name (Legal Business Name): TURQUOISE THERAPEUTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N KINGSWAY DR
AURORA IL
60506-7330
US

IV. Provider business mailing address

155 N KINGSWAY DR
AURORA IL
60506-7330
US

V. Phone/Fax

Practice location:
  • Phone: 708-646-7384
  • Fax:
Mailing address:
  • Phone: 708-505-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN ZIMAN
Title or Position: MANAGING MEMBER
Credential: PT, ATC
Phone: 708-646-7384