Healthcare Provider Details

I. General information

NPI: 1154448637
Provider Name (Legal Business Name): PHYSICAL THERAPY AND SPORTS INJURY REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 170TH ST
HAZEL CREST IL
60429-1451
US

IV. Provider business mailing address

1816 170TH ST
HAZEL CREST IL
60429-1451
US

V. Phone/Fax

Practice location:
  • Phone: 708-335-1415
  • Fax: 708-335-4792
Mailing address:
  • Phone: 708-335-1415
  • Fax: 708-335-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: GREGORY WALTER KAUMEYER
Title or Position: CO-OWNER
Credential: P.T.
Phone: 708-335-1415