Provider Demographics
NPI:1760437180
Name:THERASYS CORPORATION
Entity Type:Organization
Organization Name:THERASYS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:847-631-6227
Mailing Address - Street 1:5005 NEWPORT DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3832
Mailing Address - Country:US
Mailing Address - Phone:847-631-6227
Mailing Address - Fax:847-797-1337
Practice Address - Street 1:10751 163RD PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8861
Practice Address - Country:US
Practice Address - Phone:708-349-3377
Practice Address - Fax:708-349-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635363OtherBLUE CROSS BLUE SHIELD
IL213437Medicare ID - Type Unspecified