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General NPI Number Information
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NPI Number | 1366728560
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Entity Type | Organization
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Legal Business Name | IN-HOME PHYSICAL THERAPY AND WELLNESS, LLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 7 MILLBROOK CT
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City | ALGONQUIN
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State | IL
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Zip | 60102-2542
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Country | US
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Telephone | 217-653-6814
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Fax | 877-482-0929
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Provider Business Mailing Address
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Address Line | 7 MILLBROOK CT
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City | ALGONQUIN
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State | IL
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Zip | 60102-2542
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Country | US
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Telephone | 217-653-6814
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Fax | 877-482-0929
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. MICHAEL GAMBOA RIVERA
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Credential | PT
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Telephone | 12176536814
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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 |
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License Number State |
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