Provider Demographics
NPI:1073658043
Name:MIDWEST PHYSICAL THERAPY CTR
Entity Type:Organization
Organization Name:MIDWEST PHYSICAL THERAPY CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-285-8007
Mailing Address - Street 1:1000 E STATE PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4569
Mailing Address - Country:US
Mailing Address - Phone:630-285-8007
Mailing Address - Fax:630-285-8017
Practice Address - Street 1:1000 WELLINGTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-7332
Practice Address - Country:US
Practice Address - Phone:847-228-2866
Practice Address - Fax:847-228-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621171OtherBCBS PROVIDER NUMBER
IL01621171OtherBCBS PROVIDER NUMBER