=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649318833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL THERAPY REHAB OF ILLINOIS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 06/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 E BUTTERFIELD RD STE. #154
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-5103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-639-1153
-----------------------------------------------------
Fax | 630-261-0716
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1S132 SUMMIT AVE STE. #108
-----------------------------------------------------
City | OAKBROOK TERRACE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60181-3955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-261-0727
-----------------------------------------------------
Fax | 630-261-0716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HOSSAM R MOHAMED
-----------------------------------------------------
Credential | LPT
-----------------------------------------------------
Telephone | 630-639-1153
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070-007491
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------