Provider Demographics
NPI:1700859428
Name:MODI, HEMAL (PT)
Entity Type:Individual
Prefix:
First Name:HEMAL
Middle Name:
Last Name:MODI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1667
Mailing Address - Country:US
Mailing Address - Phone:184-739-1972
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1667
Practice Address - Country:US
Practice Address - Phone:184-739-1972
Practice Address - Fax:773-767-3944
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635425OtherBC/BS PROVIDER #
IL01635425OtherBC/BS PROVIDER #