Provider Demographics
NPI:1205812781
Name:PHYSICAL THERAPY SERVICES PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:217-228-2853
Mailing Address - Street 1:4531 MAINE ST
Mailing Address - Street 2:STE C
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5872
Mailing Address - Country:US
Mailing Address - Phone:217-228-2853
Mailing Address - Fax:217-228-2868
Practice Address - Street 1:4531 MAINE ST
Practice Address - Street 2:STE C
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5872
Practice Address - Country:US
Practice Address - Phone:217-228-2853
Practice Address - Fax:217-228-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
762900Medicare ID - Type Unspecified