Provider Demographics
NPI:1629211362
Name:FUNCTIONAL THERAPY SPECIALISTS PC
Entity Type:Organization
Organization Name:FUNCTIONAL THERAPY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-941-8190
Mailing Address - Street 1:401 N YORK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5510
Mailing Address - Country:US
Mailing Address - Phone:630-941-8190
Mailing Address - Fax:630-941-8194
Practice Address - Street 1:401 N YORK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5510
Practice Address - Country:US
Practice Address - Phone:630-941-8190
Practice Address - Fax:630-941-8194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED HEALTH SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty