Provider Demographics
NPI:1669005930
Name:ILLINOIS THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:ILLINOIS THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONA
Authorized Official - Middle Name:CAJES
Authorized Official - Last Name:ALZONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-338-8930
Mailing Address - Street 1:6055 N LINCOLN AVE STE 102B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2435
Mailing Address - Country:US
Mailing Address - Phone:773-338-8930
Mailing Address - Fax:773-338-8932
Practice Address - Street 1:6055 N LINCOLN AVE STE 102B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2435
Practice Address - Country:US
Practice Address - Phone:773-338-8930
Practice Address - Fax:773-338-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty