Provider Demographics
NPI:1841575487
Name:MOFFETT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MOFFETT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:847-659-1000
Mailing Address - Street 1:12531 REGENCY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6500
Mailing Address - Country:US
Mailing Address - Phone:847-659-1000
Mailing Address - Fax:847-659-1012
Practice Address - Street 1:9551 ACKMAN RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-9709
Practice Address - Country:US
Practice Address - Phone:847-669-8800
Practice Address - Fax:847-669-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy