=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952547739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST THERAPY SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2008
-----------------------------------------------------
Last Update Date | 12/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5112 N OZARK AVE
-----------------------------------------------------
City | NORRIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60706-3341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-457-8634
-----------------------------------------------------
Fax | 708-575-0241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5112 N OZARK AVE
-----------------------------------------------------
City | NORRIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60706-3341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-457-8634
-----------------------------------------------------
Fax | 708-575-0241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOSEPH PAWLIK
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 708-457-8634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 060010008
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------