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General NPI Number Information
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NPI Number | 1558662973
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Entity Type | Organization
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Legal Business Name | CONVENIENT THERAPY SERVICES LLC
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 339 RICHMOND DR
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City | ROMEOVILLE
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State | IL
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Zip | 60446-5042
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Country | US
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Telephone | 630-767-9922
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Fax |
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Provider Business Mailing Address
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Address Line | 339 RICHMOND DR
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City | ROMEOVILLE
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State | IL
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Zip | 60446-5042
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Country | US
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Telephone | 630-767-9922
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Fax | 815-782-5070
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | KEITH WILLIAM SODERLUND
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Credential |
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Telephone | 630-767-9922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070012850
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License Number State | IL
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