Provider Demographics
NPI:1083489611
Name:SUPREME PHYSICAL THERAPY CO.
Entity Type:Organization
Organization Name:SUPREME PHYSICAL THERAPY CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAHELDEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELHADI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-954-7101
Mailing Address - Street 1:19643 BROOKFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7087
Mailing Address - Country:US
Mailing Address - Phone:708-954-7101
Mailing Address - Fax:
Practice Address - Street 1:19643 BROOKFIELD CIR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7087
Practice Address - Country:US
Practice Address - Phone:708-954-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy