Provider Demographics
NPI:1831325075
Name:WILLOW THERAPEUTICS, LTD
Entity Type:Organization
Organization Name:WILLOW THERAPEUTICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:RIOUS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANABAT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-483-5753
Mailing Address - Street 1:24835 FRANKLIN LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24835 FRANKLIN LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-2216
Practice Address - Country:US
Practice Address - Phone:815-483-5753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011699225100000X
IL070008654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty