Provider Demographics
NPI:1346392271
Name:CITY CENTER PHYSICAL THERAPY - JOLIET
Entity Type:Organization
Organization Name:CITY CENTER PHYSICAL THERAPY - JOLIET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEMLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-722-1757
Mailing Address - Street 1:205 E CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-2854
Mailing Address - Country:US
Mailing Address - Phone:815-126-2468
Mailing Address - Fax:815-726-4431
Practice Address - Street 1:205 E CLINTON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2854
Practice Address - Country:US
Practice Address - Phone:815-126-2468
Practice Address - Fax:815-726-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-07-16
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
ILDB8745OtherRAILROAD MEDICARE
IL09932154OtherBLUE CROSS BLUE SHIELD
IL207445Medicaid
IL207445Medicaid