Healthcare Provider Details

I. General information

NPI: 1316036585
Provider Name (Legal Business Name): PHYSICAL THERAPY & SPINE INSTITUTE LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18215 HARLEM AVE
TINLEY PARK IL
60477-3609
US

IV. Provider business mailing address

18215 HARLEM AVE
TINLEY PARK IL
60477-3609
US

V. Phone/Fax

Practice location:
  • Phone: 708-444-2563
  • Fax: 708-444-2769
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP, AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000