Provider Demographics
NPI:1689863193
Name:SYLVESTER PHYSICAL THERAPY LTD.
Entity Type:Organization
Organization Name:SYLVESTER PHYSICAL THERAPY LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPT/CEAS
Authorized Official - Phone:312-315-2459
Mailing Address - Street 1:1524 PITNER AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3961
Mailing Address - Country:US
Mailing Address - Phone:847-475-1403
Mailing Address - Fax:847-475-1434
Practice Address - Street 1:1524 PITNER AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3961
Practice Address - Country:US
Practice Address - Phone:847-475-1403
Practice Address - Fax:847-475-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209899Medicare PIN