Provider Demographics
NPI:1477693760
Name:ORTHOPEDIC & SPINESURGERY ASSOC.
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINESURGERY ASSOC.
Other - Org Name:ROYAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-931-5300
Mailing Address - Street 1:2350 ROYAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-931-5300
Mailing Address - Fax:847-931-9072
Practice Address - Street 1:308 RANDALL RD
Practice Address - Street 2:SUITE B
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4201
Practice Address - Country:US
Practice Address - Phone:630-262-0279
Practice Address - Fax:630-262-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208821Medicare ID - Type UnspecifiedKANE COUNTY