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General NPI Number Information
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NPI Number | 1376930982
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY & SPORTS INJURY REHABILITATION LTD
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 1816 170TH ST
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City | HAZEL CREST
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State | IL
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Zip | 60429-1451
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Country | US
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Telephone | 708-335-4081
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Fax |
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Provider Business Mailing Address
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Address Line | 1816 170TH ST
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City | HAZEL CREST
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State | IL
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Zip | 60429-1451
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Country | US
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Telephone | 708-335-4081
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | RONALD F AGRIGENTO
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Credential | DPT,ATC
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Telephone | 708-335-4081
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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 | 227.002610
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License Number State | IL
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