Provider Demographics
NPI:1467409094
Name:CREATIVE THERAPY RESOURCE, LLC
Entity Type:Organization
Organization Name:CREATIVE THERAPY RESOURCE, LLC
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOSI, PT, DPT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-390-0999
Mailing Address - Street 1:9519 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1211
Mailing Address - Country:US
Mailing Address - Phone:847-390-0999
Mailing Address - Fax:847-390-0949
Practice Address - Street 1:9519 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1211
Practice Address - Country:US
Practice Address - Phone:847-390-0999
Practice Address - Fax:847-390-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213172Medicare ID - Type UnspecifiedGROUP NO. MCHENRY COUNTY
IL202103Medicare ID - Type UnspecifiedGROUP NO. COOK COUNTY