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General NPI Number Information
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NPI Number | 1619615002
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Entity Type | Organization
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Legal Business Name | ST MARY THERAPY SERVICES P.C
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 7901 W 159TH STREET #C
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City | TINLEY PARK
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State | IL
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Zip | 60477
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Country | US
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Telephone | 708-620-8282
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Fax | 708-880-3180
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Provider Business Mailing Address
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Address Line | 7901 W 159TH STREET #C
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City | TINLEY PARK
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State | IL
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Zip | 60477
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Country | US
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Telephone | 708-620-8282
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Fax | 708-880-3180
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. ASHRAF YOUSSIEF SR.
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Credential | P.T
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Telephone | 708-620-8282
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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 |
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License Number State |
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