Provider Demographics
NPI:1235292111
Name:NORTHERN ILLINOIS PHYSICAL THERAPY SERVICES PC
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS PHYSICAL THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MHS
Authorized Official - Phone:815-233-5100
Mailing Address - Street 1:1763 S DIRCK DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6707
Mailing Address - Country:US
Mailing Address - Phone:815-233-5100
Mailing Address - Fax:815-235-2233
Practice Address - Street 1:1763 S DIRCK DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6707
Practice Address - Country:US
Practice Address - Phone:815-233-5100
Practice Address - Fax:815-235-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 225100000X, 225100000X, 225100000X, 225X00000X, 225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
686930Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER