Provider Demographics
NPI:1255655577
Name:MIDWEST THERAPY NETOWRK,LLC
Entity Type:Organization
Organization Name:MIDWEST THERAPY NETOWRK,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-532-5063
Mailing Address - Street 1:855 E GOLF RD
Mailing Address - Street 2:SUITE 2131
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5222
Mailing Address - Country:US
Mailing Address - Phone:224-764-9189
Mailing Address - Fax:
Practice Address - Street 1:600 OLD ROYSE RD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4435
Practice Address - Country:US
Practice Address - Phone:224-764-9189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service