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NPI Code Detail

MEDICARE: IMPACT PHYSICAL THERAPY, LLC

MEDICARE: IMPACT PHYSICAL THERAPY, 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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1508622614
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMPACT PHYSICAL THERAPY, LLC
Provider Business Mailing Address
First Line : PO BOX 220
Second Line :
City : WESTMONT
State : IL
Zip : 60559-0220
Country : US
Telephone Number : 708-590-6663
Fax Number : 709-469-4100
Provider Business Practice Location Address
First Line : 1103 S STATE ST STE 300
Second Line :
City : CHICAGO
State : IL
Zip : 60605-2775
Country : US
Telephone Number : 312-877-5101
Fax Number : 312-877-5906
Authorized Official
Title or Position : HR DIRECTOR
Name : DENISE M DEASY
Credential :
Telephone Number : 630-399-1015
Provider Enumeration Date : 02/26/2024
Last Update Date : 02/26/2024

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Directions to “IMPACT PHYSICAL THERAPY, LLC ” Practice Location

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