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General NPI Number Information
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NPI Number | 1922205178
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHYSICAL THERAPY SERVICES, P.C.
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 10201 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-1917
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Country | US
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Telephone | 773-779-7273
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Fax | 773-779-7298
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Provider Business Mailing Address
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Address Line | 10201 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-1917
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Country | US
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Telephone | 773-779-7273
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Fax | 773-779-7298
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. CHRISTY M. OLOFSSON
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Credential | O.T.R., P.T.A.
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Telephone | 773-779-7273
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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 | 070000479
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070012996
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160004410
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056002420
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License Number State | IL
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