Provider Demographics
NPI:1003149030
Name:CYPRESS THERAPY AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:CYPRESS THERAPY AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEINZ-NEWINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:217-556-1225
Mailing Address - Street 1:RR 3 BOX 46
Mailing Address - Street 2:P.O. BOX 45
Mailing Address - City:CARROLLTON
Mailing Address - State:IL
Mailing Address - Zip Code:62016-9506
Mailing Address - Country:US
Mailing Address - Phone:217-556-1225
Mailing Address - Fax:214-942-3717
Practice Address - Street 1:RR 3 BOX 46
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:IL
Practice Address - Zip Code:62016-9506
Practice Address - Country:US
Practice Address - Phone:217-556-1225
Practice Address - Fax:214-942-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005569252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency