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General NPI Number Information
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NPI Number | 1265814032
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Entity Type | Organization
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Legal Business Name | TRACI HELLER PHYSICAL THERAPY GROUP
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 1200 OLD SKOKIE VALLEY RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3036
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Country | US
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Telephone | 847-989-3749
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Fax |
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Provider Business Mailing Address
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Address Line | 475 SOMERSET HILLS CT
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City | RIVERWOODS
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State | IL
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Zip | 60015-3845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ADAM MILLSTEIN
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Credential |
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Telephone | 847-770-6051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070005430
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License Number State | IL
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