Provider Demographics
NPI:1659345262
Name:WEST PHYSICAL THERAPY P C
Entity Type:Organization
Organization Name:WEST PHYSICAL THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-466-5866
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-0274
Mailing Address - Country:US
Mailing Address - Phone:630-466-5866
Mailing Address - Fax:630-466-5869
Practice Address - Street 1:38 S MAIN ST
Practice Address - Street 2:SUITE A & B
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5031
Practice Address - Country:US
Practice Address - Phone:630-466-5866
Practice Address - Fax:630-466-5869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-008969 70-005680261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04527354OtherBLUE CROSS BLUE SHIELD
ILAPPLICATION PENDINGOtherPHCS
ILAPPLICATION PENDINGOtherAETNA
IL04527354OtherBLUE CROSS BLUE SHIELD
IL205522Medicare ID - Type Unspecified
ILAPPLICATION PENDINGOtherAETNA