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General NPI Number Information
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NPI Number | 1346368347
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Entity Type | Organization
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Legal Business Name | PENTAFIL PHYSICAL THERAPY SERVICE
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 790 ROYAL SAINT GEORGE DR SUITE 105
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City | NAPERVILLE
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State | IL
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Zip | 60563-8955
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Country | US
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Telephone | 630-527-6370
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Fax | 630-527-6374
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Provider Business Mailing Address
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Address Line | 790 ROYAL SAINT GEORGE DR SUITE 105
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City | NAPERVILLE
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State | IL
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Zip | 60563-8955
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Country | US
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Telephone | 630-527-6370
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Fax | 630-527-6374
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS OLYMPHIA ROLDAN TESORO
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Credential | P.T.
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Telephone | 630-527-6370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | IL
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