Provider Demographics
NPI: | 1669500609 |
---|---|
Name: | HILLMANN PEDIATRIC THERAPY |
Entity Type: | Organization |
Organization Name: | HILLMANN PEDIATRIC THERAPY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BUS. MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LISA |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | MCNICHOLAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 815-730-1800 |
Mailing Address - Street 1: | 863 CENTER COURT UNIT D |
Mailing Address - Street 2: | |
Mailing Address - City: | SHOREWOOD |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60404 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 815-730-1800 |
Mailing Address - Fax: | 815-730-1835 |
Practice Address - Street 1: | 860 CENTER COURT-UNIT C |
Practice Address - Street 2: | |
Practice Address - City: | SHOREWOOD |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60404 |
Practice Address - Country: | US |
Practice Address - Phone: | 815-773-9000 |
Practice Address - Fax: | 815-773-9001 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-01 |
Last Update Date: | 2021-05-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | ========= | Medicaid | |
IL | ========= | Medicaid |