Provider Demographics
NPI:1275079501
Name:DEERFIELD PHYSICAL THERAPY, LTD
Entity Type:Organization
Organization Name:DEERFIELD PHYSICAL THERAPY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HALINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-877-1207
Mailing Address - Street 1:707 LAKE COOK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5613
Mailing Address - Country:US
Mailing Address - Phone:847-509-0600
Mailing Address - Fax:847-580-1215
Practice Address - Street 1:707 LAKE COOK RD STE 120
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4909
Practice Address - Country:US
Practice Address - Phone:847-509-0600
Practice Address - Fax:847-580-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1366689911Medicare PIN