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General NPI Number Information
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NPI Number | 1558895797
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Entity Type | Organization
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Legal Business Name | HUNTLEY PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 10395 VINE ST
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City | HUNTLEY
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State | IL
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Zip | 60142-9589
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Country | US
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Telephone | 815-893-8480
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Fax | 815-893-8481
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Provider Business Mailing Address
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Address Line | 530 ROCKLAND RD STE 500
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-4131
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Country | US
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Telephone | 815-893-8480
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Fax | 815-893-8481
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Authorized Official
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Title or Position | PRESIDENT
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Name | EMILY CRAIGEN
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Credential |
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Telephone | 815-893-8480
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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 | 070016104
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License Number State | IL
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