Provider Demographics
NPI:1740589654
Name:ALLSTAR PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ALLSTAR PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ZICKUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:314-603-8299
Mailing Address - Street 1:221 W POINTE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8306
Mailing Address - Country:US
Mailing Address - Phone:618-416-6500
Mailing Address - Fax:618-416-6503
Practice Address - Street 1:221 W POINTE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8306
Practice Address - Country:US
Practice Address - Phone:618-416-6500
Practice Address - Fax:618-416-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty