Healthcare Provider Details

I. General information

NPI: 1730109596
Provider Name (Legal Business Name): NEW LIFE PHYSICAL THERAPY AND REHABILITATION P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25622 S GOVERNORS HWY
MONEE IL
60449-8987
US

IV. Provider business mailing address

25622 S GOVERNORS HWY
MONEE IL
60449-8987
US

V. Phone/Fax

Practice location:
  • Phone: 708-235-0144
  • Fax: 708-235-0145
Mailing address:
  • Phone: 708-774-2970
  • Fax: 708-460-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID J KOOYENGA
Title or Position: OFFICER
Credential: P.T.
Phone: 708-774-2970