Healthcare Provider Details

I. General information

NPI: 1699786558
Provider Name (Legal Business Name): MIDWEST PHYSICAL THERAPY CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E STATE PKWY SUITE E
SCHAUMBURG IL
60173-4569
US

IV. Provider business mailing address

1000 E STATE PKWY SUITE E
SCHAUMBURG IL
60173-4569
US

V. Phone/Fax

Practice location:
  • Phone: 630-285-8007
  • Fax: 630-285-8017
Mailing address:
  • Phone: 630-285-8007
  • Fax: 630-285-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CRAIG L KRUSE
Title or Position: DIRECTOR OF PHYSICAL THERAPY
Credential: PT
Phone: 630-285-8007