Provider Demographics
NPI:1417680810
Name:ACHIEVE ORTHOPEDIC MANUAL THERAPY PARK RIDGE, PLLC
Entity Type:Organization
Organization Name:ACHIEVE ORTHOPEDIC MANUAL THERAPY PARK RIDGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR/CRED REP
Authorized Official - Prefix:
Authorized Official - First Name:JANUARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-300-3770
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-0228
Mailing Address - Country:US
Mailing Address - Phone:630-371-1623
Mailing Address - Fax:630-371-1546
Practice Address - Street 1:422 N NORTHWEST HWY STE 200
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3273
Practice Address - Country:US
Practice Address - Phone:847-384-8511
Practice Address - Fax:847-384-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy