Healthcare Provider Details

I. General information

NPI: 1912840141
Provider Name (Legal Business Name): PLYMOUTH PLACE MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N LA GRANGE RD
LA GRANGE PARK IL
60526-5695
US

IV. Provider business mailing address

315 N LA GRANGE RD
LA GRANGE PARK IL
60526-5695
US

V. Phone/Fax

Practice location:
  • Phone: 708-588-6995
  • Fax:
Mailing address:
  • Phone: 708-588-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIDGET REILLY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 708-588-6995