Healthcare Provider Details
I. General information
NPI: 1497727143
Provider Name (Legal Business Name): THERAPEDS INTERVENTION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/06/2006
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1409 N RIDGEWAY AVE
CHICAGO IL
60651-2160
US
IV. Provider business mailing address
1409 N RIDGEWAY AVE
CHICAGO IL
60651-2160
US
V. Phone/Fax
- Phone: 773-818-3535
- Fax: 866-391-1051
- Phone: 773-818-3535
- Fax: 866-391-1051
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2251P0200X |
| Taxonomy | Pediatric Physical Therapist |
| License Number | |
| License Number State | NULL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XP0200X |
| Taxonomy | Pediatric Occupational Therapist |
| License Number | |
| License Number State | NULL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 235Z00000X |
| Taxonomy | Speech-Language Pathologist |
| License Number | |
| License Number State | NULL |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 251E00000X |
| Taxonomy | Home Health Agency |
| License Number | 070-011157 |
| License Number State | IL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 222Q00000X |
| Taxonomy | Developmental Therapist |
| License Number | |
| License Number State | NULL |
VIII. Authorized Official
Name: MS.
HOA
TU
Title or Position: FOUNDER/PHYSICAL THERAPIST
Credential: PT
Phone: 773-818-3535