Provider Demographics
NPI:1295380707
Name:RECOVERRX PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:RECOVERRX PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:331-253-2426
Mailing Address - Street 1:17W775 BUTTERFIELD RD STE 128
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4535
Mailing Address - Country:US
Mailing Address - Phone:331-253-2426
Mailing Address - Fax:833-506-3220
Practice Address - Street 1:17W775 BUTTERFIELD RD STE 128
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4535
Practice Address - Country:US
Practice Address - Phone:331-253-2426
Practice Address - Fax:833-506-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1396093142Medicaid
IL1629402706Medicaid
IL1942948278Medicaid
IL1295380707Medicaid
IL1851801849Medicaid