Provider Demographics
NPI:1124194022
Name:PHYSIOTHERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES
Other - Org Name:THE PEDIATRIC PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER OF PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:ZIGENFUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:901-685-7227
Mailing Address - Street 1:610 S MAPLE AVE STE 3400
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1094
Mailing Address - Country:US
Mailing Address - Phone:708-660-5880
Mailing Address - Fax:708-660-5886
Practice Address - Street 1:610 S MAPLE AVE STE 3400
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1094
Practice Address - Country:US
Practice Address - Phone:708-660-5880
Practice Address - Fax:708-660-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636250OtherBCBS OF IL