Provider Demographics
NPI:1598882391
Name:CONROY SPORTS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CONROY SPORTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-578-9655
Mailing Address - Street 1:319 NORTH FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5504
Mailing Address - Country:US
Mailing Address - Phone:815-578-9655
Mailing Address - Fax:815-578-9642
Practice Address - Street 1:319 NORTH FRONT ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5504
Practice Address - Country:US
Practice Address - Phone:815-578-9655
Practice Address - Fax:815-578-9642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-25
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632057OtherBLUECROSS BLUESHIELD
IL601014700OtherACS OWCP
IL7515430OtherAETNA
IL05632289OtherBLUE CROSS BLUE SHIELD
IL7515430OtherAETNA