Healthcare Provider Details

I. General information

NPI: 1457755167
Provider Name (Legal Business Name): HEALING HANDS PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 ARCHER AVE SUITE 21
WILLOW SPRINGS IL
60480-1260
US

IV. Provider business mailing address

8695 ARCHER AVE SUITE 21
WILLOW SPRINGS IL
60480-1260
US

V. Phone/Fax

Practice location:
  • Phone: 708-915-0950
  • Fax:
Mailing address:
  • Phone: 708-915-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070017865
License Number StateIL

VIII. Authorized Official

Name: DR. SUSANE MUKDAD
Title or Position: DOCTOR OF PHYSICAL THERAPY/OWNER
Credential: DPT
Phone: 708-915-0950