Provider Demographics
NPI:1629211636
Name:PT OF ILLINOIS
Entity Type:Organization
Organization Name:PT OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGVINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-480-7877
Mailing Address - Street 1:425 HUEHL
Mailing Address - Street 2:BUILDING 20
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:224-406-8990
Mailing Address - Fax:224-406-8995
Practice Address - Street 1:1227 S CHRISTINE CT
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061
Practice Address - Country:US
Practice Address - Phone:224-406-8990
Practice Address - Fax:224-406-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.009737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty