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General NPI Number Information
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NPI Number | 1598988271
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Entity Type | Organization
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Legal Business Name | ORTHOSPORT PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 313 N WEBER RD
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City | BOLINGBROOK
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State | IL
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Zip | 60490-1569
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Country | US
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Telephone | 630-771-0582
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 HONEST PLEASURE DR
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City | NAPERVILLE
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State | IL
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Zip | 60540-7622
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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 | PHYSICAL THERAPIST
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Name | MR. RYAN COLIN ALBERT
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Credential | PT, DPT
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Telephone | 630-961-3127
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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 | 70015125
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License Number State | IL
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