Provider Demographics
NPI:1780862573
Name:GRIFFIN, ROBERT K (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:GRIFFIN
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-0220
Mailing Address - Country:US
Mailing Address - Phone:708-590-6663
Mailing Address - Fax:708-469-4100
Practice Address - Street 1:15441 S 94TH AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3827
Practice Address - Country:US
Practice Address - Phone:708-981-3715
Practice Address - Fax:708-315-7087
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200852OtherMEDICARE GROUP #
IL1623066OtherBCBS PROVIDER #
IL202542OtherMEDICARE GROUP #
IL367885100OtherU.S. DEPT. OF LABOR
IL1619908OtherBCBS OF IL
IL200852OtherMEDICARE GROUP #
IL1623066OtherBCBS PROVIDER #
IL568150Medicare PIN
ILR02994Medicare PIN
ILR02992Medicare PIN
IL1619908OtherBCBS OF IL