Provider Demographics
NPI:1619615002
Name:ST MARY THERAPY SERVICES P.C
Entity Type:Organization
Organization Name:ST MARY THERAPY SERVICES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSSIEF
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT
Authorized Official - Phone:708-620-8282
Mailing Address - Street 1:7901 W 159TH STREET #C
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477
Mailing Address - Country:US
Mailing Address - Phone:708-620-8282
Mailing Address - Fax:708-880-3180
Practice Address - Street 1:7901 W 159TH STREET #C
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477
Practice Address - Country:US
Practice Address - Phone:708-620-8282
Practice Address - Fax:708-880-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070007546Medicaid