MEDICARE: TRUE FAITH REHABILITATIVE SERVICES, LTD

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	225100000X	Physical Therapist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7458706	OTHER	IL	AETNA
2	01635458	OTHER	IL	BLUE CROSS BLUE SHIELD
3	5655353	OTHER	IL	FIRST HEALTH CCN

General Provider Information

NPI Number	:	1467570796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE FAITH REHABILITATIVE SERVICES, LTD

Provider Business Mailing Address
First Line	:	5524 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1406
Country	:	US
Telephone Number	:	773-561-7342
Fax Number	:

Provider Business Practice Location Address
First Line	:	5524 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1406
Country	:	US
Telephone Number	:	773-561-7342
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. JAMES IBARDALOZA
Credential	:	P.T.
Telephone Number	:	773-561-7342

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2020

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Directions to “TRUE FAITH REHABILITATIVE SERVICES, LTD ” Practice Location

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