Healthcare Provider Details

I. General information

NPI: 1245280213
Provider Name (Legal Business Name): VICTORY AMBULATORY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 RED OAK LN
LINDENHURST IL
60046-4998
US

IV. Provider business mailing address

1050 RED OAK LN
LINDENHURST IL
60046-4998
US

V. Phone/Fax

Practice location:
  • Phone: 847-356-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number7002322
License Number StateIL

VIII. Authorized Official

Name: BARBARA J. MARTIN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 847-360-3000