Provider Demographics
NPI:1548572969
Name:ST. MARY THERAPY SERVICES
Entity Type:Organization
Organization Name:ST. MARY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:N
Authorized Official - Last Name:YOUSSIEF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-945-8416
Mailing Address - Street 1:7903. W. 159TH ST
Mailing Address - Street 2:#A
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477
Mailing Address - Country:US
Mailing Address - Phone:708-444-3000
Mailing Address - Fax:708-444-3003
Practice Address - Street 1:2455 W 79TH ST
Practice Address - Street 2:#101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652
Practice Address - Country:US
Practice Address - Phone:773-737-8000
Practice Address - Fax:773-737-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007546261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy