Healthcare Provider Details

I. General information

NPI: 1497181382
Provider Name (Legal Business Name): E-ZTHERAPY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 KINGSDALE RD
HOFFMAN ESTATES IL
60169-1215
US

IV. Provider business mailing address

1290 KINGSDALE RD
HOFFMAN ESTATES IL
60169-1215
US

V. Phone/Fax

Practice location:
  • Phone: 224-875-1012
  • Fax: 847-781-5246
Mailing address:
  • Phone: 224-875-1012
  • Fax: 847-781-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070.007385
License Number StateIL

VIII. Authorized Official

Name: HEMAN EZRA
Title or Position: OWNER
Credential: PT
Phone: 224-875-1012