Provider Demographics
NPI:1518213529
Name:ADVANCED PHYSICAL THERAPY & REHABILITATION
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANUSZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PARZUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-741-5678
Mailing Address - Street 1:6737 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2112
Mailing Address - Country:US
Mailing Address - Phone:708-741-5678
Mailing Address - Fax:708-741-5679
Practice Address - Street 1:5725 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-1617
Practice Address - Country:US
Practice Address - Phone:708-741-5678
Practice Address - Fax:708-741-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy