Provider Demographics
NPI:1568762284
Name:COMUNITY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COMUNITY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, DSC
Authorized Official - Phone:630-766-0505
Mailing Address - Street 1:721 W LAKE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2091
Mailing Address - Country:US
Mailing Address - Phone:630-543-7450
Mailing Address - Fax:630-543-7475
Practice Address - Street 1:721 W LAKE ST STE 110
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2091
Practice Address - Country:US
Practice Address - Phone:630-543-7450
Practice Address - Fax:630-543-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010142261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy