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General NPI Number Information
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NPI Number | 1104335462
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Entity Type | Organization
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Legal Business Name | ILLINOIS THERAPEUTIC AND NURSING SERVICES, LLC
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 6055 N LINCOLN AVE STE 102B
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City | CHICAGO
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State | IL
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Zip | 60659-2435
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Country | US
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Telephone | 773-338-8930
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Fax |
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Provider Business Mailing Address
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Address Line | 6055 N LINCOLN AVE STE 102B
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City | CHICAGO
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State | IL
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Zip | 60659-2435
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Country | US
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Telephone | 773-337-7830
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Fax | 773-338-8932
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH CAJES ALZONA
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Credential | PHYSICAL THERAPIST
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Telephone | 773-338-8930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 070012538
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License Number State | IL
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