Provider Demographics
NPI:1376688176
Name:HARVARD PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HARVARD PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GULBRANDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-516-8095
Mailing Address - Street 1:2615 3 OAKS RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-6127
Mailing Address - Country:US
Mailing Address - Phone:847-516-8095
Mailing Address - Fax:847-516-8095
Practice Address - Street 1:343 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-3276
Practice Address - Country:US
Practice Address - Phone:815-943-0191
Practice Address - Fax:815-943-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7153220OtherAETNA
IL05632091OtherBLUE CROSS BLUE SHIELD
IL7153220OtherAETNA