Provider Demographics
NPI:1558662973
Name:CONVENIENT THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:CONVENIENT THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SODERLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-767-9922
Mailing Address - Street 1:339 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5042
Mailing Address - Country:US
Mailing Address - Phone:630-767-9922
Mailing Address - Fax:815-782-5070
Practice Address - Street 1:339 RICHMOND DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-5042
Practice Address - Country:US
Practice Address - Phone:630-767-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty