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General NPI Number Information
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NPI Number | 1457755167
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Entity Type | Organization
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Legal Business Name | HEALING HANDS PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 8695 ARCHER AVE SUITE 21
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City | WILLOW SPRINGS
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State | IL
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Zip | 60480-1260
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Country | US
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Telephone | 708-915-0950
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Fax |
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Provider Business Mailing Address
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Address Line | 8695 ARCHER AVE SUITE 21
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City | WILLOW SPRINGS
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State | IL
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Zip | 60480-1260
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Country | US
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Telephone | 708-915-0950
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY/OWNER
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Name | DR. SUSANE MUKDAD
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Credential | DPT
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Telephone | 708-915-0950
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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 | 070017865
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License Number State | IL
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