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General NPI Number Information
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NPI Number | 1568749489
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Entity Type | Organization
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Legal Business Name | ACCESS THERAPY GROUP, LLC
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Dates
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Enumeration Date | 11/06/2011
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Last Update Date | 11/06/2011
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Provider Practice Location Address
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Address Line | 1103 S FERN DR
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City | MT PROSPECT
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State | IL
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Zip | 60056-4521
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Country | US
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Telephone | 312-493-6548
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 S FERN DR
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City | MT PROSPECT
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State | IL
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Zip | 60056-4521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HUMAN RESOURCES
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Name | MR. CHRISTOPHER STA.MARIA YAMAT
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Credential |
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Telephone | 312-493-6548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 070012926
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License Number State | IL
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