Provider Demographics
NPI:1518071190
Name:ACTION THERAPY SERVICES, LTD.
Entity Type:Organization
Organization Name:ACTION THERAPY SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MIKUZIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-725-4919
Mailing Address - Street 1:850 BROOK FOREST AVE
Mailing Address - Street 2:UNIT I
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8513
Mailing Address - Country:US
Mailing Address - Phone:815-725-4919
Mailing Address - Fax:815-725-9449
Practice Address - Street 1:850 BROOK FOREST AVE
Practice Address - Street 2:UNIT I
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-8513
Practice Address - Country:US
Practice Address - Phone:815-725-4919
Practice Address - Fax:815-725-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932300OtherBCBS
IL210755Medicare PIN
IL9932300OtherBCBS