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General NPI Number Information
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NPI Number | 1760550362
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Entity Type | Organization
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Legal Business Name | PRIME TECH SERVICES INC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 1460 MARKET ST SUITE 300
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City | DES PLAINES
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State | IL
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Zip | 60016-4643
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Country | US
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Telephone | 630-573-1979
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 BUTTERFIELD RD SUITE 300S
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City | OAK BROOK
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State | IL
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Zip | 60523-1234
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Country | US
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Telephone | 630-573-1979
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL SULLIVAN
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Credential |
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Telephone | 630-573-1979
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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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