Healthcare Provider Details

I. General information

NPI: 1467742437
Provider Name (Legal Business Name): MIDWEST PHYSICAL THERAPY CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 N RANDALL RD SUITE 105
ELGIN IL
60123-2306
US

IV. Provider business mailing address

1000 E STATE PKWY SUITE E
SCHAUMBURG IL
60173-4569
US

V. Phone/Fax

Practice location:
  • Phone: 847-214-1305
  • Fax: 847-214-1364
Mailing address:
  • Phone: 630-285-8007
  • Fax: 630-285-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEVINDER DEOL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 630-285-8007