=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477957496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFINITY OFFICE AND BILLING SUPPORT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2014
-----------------------------------------------------
Last Update Date | 04/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 N HICKS RD
-----------------------------------------------------
City | PALATINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60067-3608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-348-6833
-----------------------------------------------------
Fax | 847-886-7525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8770 WEST BRYN MAWR STE 1300
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60631-3557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-348-6833
-----------------------------------------------------
Fax | 847-886-7525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | PAULINE PERALTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-348-6833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------