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General NPI Number Information
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NPI Number | 1568687705
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Entity Type | Organization
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Legal Business Name | MID AMERICAN PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 04/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9830 RIDGELAND AVE
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2667
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Country | US
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Telephone | 708-422-8150
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Fax | 708-422-8160
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Provider Business Mailing Address
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Address Line | 9830 RIDGELAND AVE
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2667
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Country | US
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Telephone | 708-422-8150
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Fax | 708-422-8160
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Authorized Official
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Title or Position | PRRESIDENT
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Name | ATEF SALAMA
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Credential | PHYSICAL THERAPIST
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Telephone | 773-297-2894
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | IL
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