Provider Demographics
NPI:1578510905
Name:FRANKFORT SPINAL REHABILITATION & PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:FRANKFORT SPINAL REHABILITATION & PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NISIVOCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:708-478-3000
Mailing Address - Street 1:19600 LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9321
Mailing Address - Country:US
Mailing Address - Phone:708-478-3000
Mailing Address - Fax:708-478-3007
Practice Address - Street 1:19600 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9321
Practice Address - Country:US
Practice Address - Phone:708-478-3000
Practice Address - Fax:708-478-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004843111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209486Medicare PIN