MEDICARE: HOME BOUND HEALTHCARE OUTPATIENT THERAPY SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1265686539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME BOUND HEALTHCARE OUTPATIENT THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	14200 MCCARTHY RD
Second Line	:
City	:	LEMONT
State	:	IL
Zip	:	60439-9393
Country	:	US
Telephone Number	:	847-288-1650
Fax Number	:	847-288-1660

Provider Business Practice Location Address
First Line	:	14200 MCCARTHY RD
Second Line	:
City	:	LEMONT
State	:	IL
Zip	:	60439-9393
Country	:	US
Telephone Number	:	847-288-1650
Fax Number	:	847-288-1660

Authorized Official
Title or Position	:	PRESIDENT/SECRETARY/TREASURER
Name	:	MRS. JULIETA MITRA
Credential	:
Telephone Number	:	630-863-7881

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	02/01/2017

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