Provider Demographics
NPI:1396227302
Name:UNIVERSAL PHYSICAL THERAPY PROVIDERS, INC
Entity Type:Organization
Organization Name:UNIVERSAL PHYSICAL THERAPY PROVIDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOLYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ILAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-931-5926
Mailing Address - Street 1:1886 TECHNY CT
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5474
Mailing Address - Country:US
Mailing Address - Phone:847-707-3779
Mailing Address - Fax:847-919-6794
Practice Address - Street 1:1886 TECHNY CT
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5474
Practice Address - Country:US
Practice Address - Phone:847-707-3779
Practice Address - Fax:847-919-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy