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General NPI Number Information
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NPI Number | 1679520233
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Entity Type | Organization
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Legal Business Name | PERFORMANCE PHYSICAL THERAPY OF SOUTH HOLLAND LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 426 E 162ND ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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Country | US
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Telephone | 708-333-0677
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Fax | 708-333-1170
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Provider Business Mailing Address
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Address Line | 426 E 162ND ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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Country | US
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Telephone | 708-333-0677
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Fax | 708-333-1170
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Authorized Official
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Title or Position | PARTNER
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Name | JAMES D JUDGE
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Credential |
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Telephone | 219-979-2730
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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 |
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License Number State |
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