Provider Demographics
NPI:1235240037
Name:PRAXIS PHYSICAL THERAPY AND HUMAN PERFORMANCE PC
Entity Type:Organization
Organization Name:PRAXIS PHYSICAL THERAPY AND HUMAN PERFORMANCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KORDECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT SCS ATC
Authorized Official - Phone:847-247-7200
Mailing Address - Street 1:935 LAKEVIEW PARKWAY
Mailing Address - Street 2:SUITE 195
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:847-247-7200
Mailing Address - Fax:847-247-4340
Practice Address - Street 1:935 LAKEVIEW PARKWAY
Practice Address - Street 2:SUITE 195
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061
Practice Address - Country:US
Practice Address - Phone:847-247-7200
Practice Address - Fax:847-247-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4932356OtherBCBS
IL210184Medicare ID - Type Unspecified