MEDICARE: UNLIMITED MOBILITY THERAPY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225XP0200X	Pediatric Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	2251P0200X	Pediatric Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01635359	OTHER	IL	BLUE SHIELD PROVIDER #

General Provider Information

NPI Number	:	1194873935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNLIMITED MOBILITY THERAPY, INC

Provider Business Mailing Address
First Line	:	18428 GOVERNORS HWY
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-2911
Country	:	US
Telephone Number	:	708-799-5569
Fax Number	:	708-799-5618

Provider Business Practice Location Address
First Line	:	18430 GOVERNORS HWY
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-2911
Country	:	US
Telephone Number	:	708-799-5569
Fax Number	:	708-799-5618

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. AMBER DANIELLE BRIM
Credential	:	P.T.
Telephone Number	:	708-799-5569

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	01/28/2015

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