Provider Demographics
NPI:1275682999
Name:PHYSIOTHERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIGENFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-685-7227
Mailing Address - Street 1:13011 S 104TH AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1506
Mailing Address - Country:US
Mailing Address - Phone:708-923-0991
Mailing Address - Fax:708-923-9921
Practice Address - Street 1:13011 S 104TH AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1506
Practice Address - Country:US
Practice Address - Phone:708-923-0991
Practice Address - Fax:708-923-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146667Medicare Oscar/Certification