Provider Demographics
NPI:1285823260
Name:COUNTY WEST PHYSICIAL THERAPY, PC
Entity Type:Organization
Organization Name:COUNTY WEST PHYSICIAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASCHING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-426-2348
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:HERSCHER
Mailing Address - State:IL
Mailing Address - Zip Code:60941-0572
Mailing Address - Country:US
Mailing Address - Phone:815-426-2348
Mailing Address - Fax:815-426-2631
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HERSCHER
Practice Address - State:IL
Practice Address - Zip Code:60941-0572
Practice Address - Country:US
Practice Address - Phone:815-426-2348
Practice Address - Fax:815-426-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
216918Medicare PIN