Provider Demographics
NPI:1316219108
Name:PRIME PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PRIME PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:NOREEN
Authorized Official - Last Name:COLLADO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-271-6408
Mailing Address - Street 1:183 N EAST RIVER RD
Mailing Address - Street 2:C5
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1251
Mailing Address - Country:US
Mailing Address - Phone:847-271-6408
Mailing Address - Fax:
Practice Address - Street 1:183 N EAST RIVER RD
Practice Address - Street 2:C5
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1251
Practice Address - Country:US
Practice Address - Phone:847-271-6408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016523261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy