Provider Demographics
NPI:1467570796
Name:TRUE FAITH REHABILITATIVE SERVICES, LTD
Entity Type:Organization
Organization Name:TRUE FAITH REHABILITATIVE SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:IBARDALOZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-561-7342
Mailing Address - Street 1:5524 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1406
Mailing Address - Country:US
Mailing Address - Phone:773-561-7342
Mailing Address - Fax:
Practice Address - Street 1:5524 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1406
Practice Address - Country:US
Practice Address - Phone:773-561-7342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
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
IL7458706OtherAETNA
IL01635458OtherBLUE CROSS BLUE SHIELD
IL5655353OtherFIRST HEALTH CCN
IL=========OtherACN PROVIDER NUMBER
IL5655353OtherFIRST HEALTH CCN