Healthcare Provider Details

I. General information

NPI: 1467486787
Provider Name (Legal Business Name): MOFFETT PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12531 REGENCY PKWY
HUNTLEY IL
60142-6500
US

IV. Provider business mailing address

12531 REGENCY PKWY
HUNTLEY IL
60142-6500
US

V. Phone/Fax

Practice location:
  • Phone: 847-659-1000
  • Fax: 847-659-1012
Mailing address:
  • Phone: 847-659-1000
  • Fax: 847-659-1012

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: CHERYL A MOFFETT
Title or Position: PRESIDENT
Credential: MPT
Phone: 847-659-1000