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General NPI Number Information
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NPI Number | 1316219108
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Entity Type | Organization
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Legal Business Name | PRIME PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 183 N EAST RIVER RD C5
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City | DES PLAINES
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State | IL
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Zip | 60016-1251
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Country | US
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Telephone | 847-271-6408
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Fax |
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Provider Business Mailing Address
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Address Line | 183 N EAST RIVER RD C5
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City | DES PLAINES
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State | IL
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Zip | 60016-1251
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Country | US
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Telephone | 847-271-6408
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPY
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Name | MARIA NOREEN COLLADO
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Credential | PT
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Telephone | 847-271-6408
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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 | 070016523
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License Number State | IL
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