Healthcare Provider Details

I. General information

NPI: 1881738060
Provider Name (Legal Business Name): MIDWEST PHYSICAL THERAPY CNTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 LARKIN AVE SUITE 1
ELGIN IL
60123-5827
US

IV. Provider business mailing address

500 PARK BLVD SUITE LL80C
ITASCA IL
60143-3121
US

V. Phone/Fax

Practice location:
  • Phone: 847-289-9800
  • Fax: 847-289-9804
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