Healthcare Provider Details

I. General information

NPI: 1891363917
Provider Name (Legal Business Name): HOME THERAPY SPECIALISTS, P.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16544 PARLIAMENT AVENUE
TINLEY PARK IL
60477-2464
US

IV. Provider business mailing address

16544 PARLIAMENT AVENUE
TINLEY PARK IL
60477-2464
US

V. Phone/Fax

Practice location:
  • Phone: 708-372-2784
  • Fax: 708-235-0145
Mailing address:
  • Phone: 708-372-2784
  • Fax: 708-235-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID JOHN KOOYENGA
Title or Position: PRESIDENT
Credential: PT
Phone: 708-372-2784