Healthcare Provider Details

I. General information

NPI: 1265814032
Provider Name (Legal Business Name): TRACI HELLER PHYSICAL THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD SKOKIE VALLEY RD
HIGHLAND PARK IL
60035-3036
US

IV. Provider business mailing address

475 SOMERSET HILLS CT
RIVERWOODS IL
60015-3845
US

V. Phone/Fax

Practice location:
  • Phone: 847-989-3749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070005430
License Number StateIL

VIII. Authorized Official

Name: ADAM MILLSTEIN
Title or Position: MANAGER
Credential:
Phone: 847-770-6051