Provider Demographics
NPI:1306021241
Name:REACT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:REACT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:REAVY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-933-7374
Mailing Address - Street 1:939 W MADISON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2638
Mailing Address - Country:US
Mailing Address - Phone:312-243-9350
Mailing Address - Fax:
Practice Address - Street 1:939 W MADISON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2638
Practice Address - Country:US
Practice Address - Phone:312-243-9350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011211261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP94677Medicare UPIN