Provider Demographics
NPI:1508900796
Name:MIDWEST PHYSICAL THERPAY CTR
Entity Type:Organization
Organization Name:MIDWEST PHYSICAL THERPAY CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-285-8007
Mailing Address - Street 1:500 PARK BLVD
Mailing Address - Street 2:SUITE LL80C
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-3121
Mailing Address - Country:US
Mailing Address - Phone:630-285-8007
Mailing Address - Fax:630-285-8017
Practice Address - Street 1:505 N SPRINGINSGUTH RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-2767
Practice Address - Country:US
Practice Address - Phone:847-839-9543
Practice Address - Fax:847-839-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621171OtherBCBS PROVIDER NUMBER
IL01621171OtherBCBS PROVIDER NUMBER