Healthcare Provider Details

I. General information

NPI: 1568750107
Provider Name (Legal Business Name): TREEHOUSE PEDIATRIC THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 HOBSON RD SUITE B
WOODRIDGE IL
60517-1665
US

IV. Provider business mailing address

3020 BELLA COURT
LISLE IL
60532-1696
US

V. Phone/Fax

Practice location:
  • Phone: 312-622-6216
  • Fax:
Mailing address:
  • Phone: 630-541-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ADNAN S BHANPURI
Title or Position: OWNER
Credential:
Phone: 312-622-6216