Provider Demographics
NPI:1417965161
Name:ADVANCED PHYSICAL THERAPY & HEALTH SERVICES LLC.
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY & HEALTH SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:KOVELESKI
Authorized Official - Last Name:KRAUT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:847-268-0280
Mailing Address - Street 1:444 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3263
Mailing Address - Country:US
Mailing Address - Phone:847-268-0280
Mailing Address - Fax:847-268-0283
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3263
Practice Address - Country:US
Practice Address - Phone:847-268-0280
Practice Address - Fax:847-268-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012674225100000X
IL070-013381225100000X
IL070-014366225100000X
IL070-003166225100000X
IL070-010329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634637OtherBLUE CROSS GROUP NUMBER
IL205615Medicare PIN