Provider Demographics
NPI:1114671971
Name:THIRD EYE BLISS PT 1 LLC
Entity Type:Organization
Organization Name:THIRD EYE BLISS PT 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SACHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARALKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-975-7045
Mailing Address - Street 1:2268 GLOUCESTON LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 E BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2014
Practice Address - Country:US
Practice Address - Phone:312-975-7045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty