=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730109596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW LIFE PHYSICAL THERAPY AND REHABILITATION P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25622 S GOVERNORS HWY
-----------------------------------------------------
City | MONEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60449-8987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-235-0144
-----------------------------------------------------
Fax | 708-235-0145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25622 S GOVERNORS HWY
-----------------------------------------------------
City | MONEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60449-8987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-774-2970
-----------------------------------------------------
Fax | 708-460-1117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | MR. DAVID J KOOYENGA
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 708-774-2970
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------