Healthcare Provider Details

I. General information

NPI: 1437223872
Provider Name (Legal Business Name): RYNDAK PHYSICAL THERAPY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W LAKE ST SUITE 100
BLOOMINGDALE IL
60108-1020
US

IV. Provider business mailing address

117 PICTON RD
ROSELLE IL
60172-3576
US

V. Phone/Fax

Practice location:
  • Phone: 630-975-9469
  • Fax: 630-295-9991
Mailing address:
  • Phone: 630-975-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-007745
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number070-007745
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number070-007745
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070-007745
License Number StateIL

VIII. Authorized Official

Name: MR. BRYAN RYNDAK
Title or Position: OWNER
Credential: PT, MHS, OCS
Phone: 630-295-9990