Provider Demographics
NPI:1891846176
Name:STAY FIT PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:STAY FIT PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SAHAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PS, MPT
Authorized Official - Phone:847-255-2348
Mailing Address - Street 1:127 W PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3135
Mailing Address - Country:US
Mailing Address - Phone:847-255-2348
Mailing Address - Fax:847-255-0308
Practice Address - Street 1:127 W PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3135
Practice Address - Country:US
Practice Address - Phone:847-255-2348
Practice Address - Fax:847-255-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636073OtherBCBS PROVIDER NUMBER
IL=========OtherTAX ID NUMBER