Healthcare Provider Details

I. General information

NPI: 1609917483
Provider Name (Legal Business Name): THERAPY PROVIDERS OF TINLEY PARK LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16650 HARLEM AVE
TINLEY PARK IL
60477-1847
US

IV. Provider business mailing address

16650 HARLEM AVE
TINLEY PARK IL
60477-1847
US

V. Phone/Fax

Practice location:
  • Phone: 708-342-1000
  • Fax: 708-342-1143
Mailing address:
  • Phone: 708-342-1000
  • Fax: 708-342-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MASHKOOR ALI KHAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 708-229-9828