Healthcare Provider Details

I. General information

NPI: 1659343713
Provider Name (Legal Business Name): ADVANCED PHYSICAL MEDICINE & THERAPY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W KENSINGTON RD STE 102
MOUNT PROSPECT IL
60056-1141
US

IV. Provider business mailing address

350 W KENSINGTON RD STE 102
MOUNT PROSPECT IL
60056-1141
US

V. Phone/Fax

Practice location:
  • Phone: 847-222-9060
  • Fax: 847-222-9130
Mailing address:
  • Phone: 847-222-9060
  • Fax: 847-222-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. VIJAY PATEL
Title or Position: PRESIDENT
Credential: DC
Phone: 847-222-9060