Provider Demographics
NPI:1275910887
Name:DR PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:DR PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ABADA
Authorized Official - Last Name:PARAGAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-715-1364
Mailing Address - Street 1:16520 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4648
Mailing Address - Country:US
Mailing Address - Phone:630-880-1364
Mailing Address - Fax:630-243-0849
Practice Address - Street 1:14228 MCCARTHY ROAD
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-7412
Practice Address - Country:US
Practice Address - Phone:630-880-1136
Practice Address - Fax:630-243-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011963261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy