Healthcare Provider Details

I. General information

NPI: 1063666220
Provider Name (Legal Business Name): PHYSICAL THERAPY AND REHAB SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E OGDEN AVE SUITE 110
HINSDALE IL
60521-3590
US

IV. Provider business mailing address

PO BOX 3497
STURTEVANT WI
53177-0300
US

V. Phone/Fax

Practice location:
  • Phone: 630-325-2664
  • Fax: 866-245-8064
Mailing address:
  • Phone: 888-201-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateWI

VIII. Authorized Official

Name: LARRY BRIAND
Title or Position: CEO
Credential:
Phone: 888-201-1040