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General NPI Number Information
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NPI Number | 1619906377
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY & REHAB SPECIALISTS, PC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 E 22ND ST STE. #305
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City | LOMBARD
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State | IL
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Zip | 60148-4977
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Country | US
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Telephone | 630-792-9790
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Fax | 630-792-9794
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Provider Business Mailing Address
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Address Line | 10 E 22ND ST STE. #305
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City | LOMBARD
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State | IL
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Zip | 60148-4977
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Country | US
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Telephone | 630-792-9790
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Fax | 630-792-9794
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Authorized Official
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Title or Position | OWNER
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Name | JAMES A DALLAS
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Credential | LPT
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Telephone | 630-792-9790
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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 | IL
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