Healthcare Provider Details

I. General information

NPI: 1780903906
Provider Name (Legal Business Name): LALONDE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4938 W 95TH ST
OAK LAWN IL
60453-2504
US

IV. Provider business mailing address

4938 W 95TH ST
OAK LAWN IL
60453-2504
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-4699
  • Fax: 708-425-4692
Mailing address:
  • Phone: 708-425-4699
  • Fax: 708-425-4692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070009203
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056008494
License Number StateIL

VIII. Authorized Official

Name: MR. IBRAHIM OLOLADE AROWOLO
Title or Position: PRESIDENT
Credential: BSC
Phone: 708-425-4699