Provider Demographics
NPI:1093408940
Name:RELIVE PHYSICAL THERAPY -95TH STREET OAK LAWN
Entity Type:Organization
Organization Name:RELIVE PHYSICAL THERAPY -95TH STREET OAK LAWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:JUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-390-3362
Mailing Address - Street 1:19070 EVERETT BLVD UNIT 204
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2073
Mailing Address - Country:US
Mailing Address - Phone:708-390-3362
Mailing Address - Fax:
Practice Address - Street 1:5141 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2455
Practice Address - Country:US
Practice Address - Phone:708-390-3362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty