Healthcare Provider Details

I. General information

NPI: 1801931928
Provider Name (Legal Business Name): NEWSOME PHYSICAL THERAPY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 ESSINGTON RD
JOLIET IL
60435-2859
US

IV. Provider business mailing address

920 ESSINGTON RD
JOLIET IL
60435-2859
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-4770
  • Fax: 815-744-1845
Mailing address:
  • Phone: 815-744-4770
  • Fax: 815-744-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name: DONNA HATZL
Title or Position: BILLING AND COLLECTIONS SUPERVISOR
Credential:
Phone: 815-744-4770