Provider Demographics
NPI:1083245179
Name:WHEATON PHYSICAL THERAPY CLINIC PLLC
Entity Type:Organization
Organization Name:WHEATON PHYSICAL THERAPY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-408-4060
Mailing Address - Street 1:567 AMY LN
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3195
Mailing Address - Country:US
Mailing Address - Phone:630-408-4060
Mailing Address - Fax:
Practice Address - Street 1:567 AMY LN
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3195
Practice Address - Country:US
Practice Address - Phone:630-408-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty