Provider Demographics
NPI:1073549424
Name:STRATFORD PHYSICAL MEDICINE LTD
Entity Type:Organization
Organization Name:STRATFORD PHYSICAL MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-222-0878
Mailing Address - Street 1:290 SPRINGFILED DRIVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2293
Mailing Address - Country:US
Mailing Address - Phone:847-222-0878
Mailing Address - Fax:847-222-1087
Practice Address - Street 1:290 SPRINGFILED DRIVE
Practice Address - Street 2:SUITE 255
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2293
Practice Address - Country:US
Practice Address - Phone:847-222-0878
Practice Address - Fax:847-222-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211681Medicare ID - Type Unspecified