Provider Demographics
NPI:1891955878
Name:MEDCOA PHYSICAL THERAPY S.C.
Entity Type:Organization
Organization Name:MEDCOA PHYSICAL THERAPY S.C.
Other - Org Name:MEDCOA PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:L P T
Authorized Official - Prefix:
Authorized Official - First Name:KYOO
Authorized Official - Middle Name:HWAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-755-1122
Mailing Address - Street 1:PO BOX 957964
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN EST
Mailing Address - State:IL
Mailing Address - Zip Code:60195-7964
Mailing Address - Country:US
Mailing Address - Phone:847-755-1122
Mailing Address - Fax:
Practice Address - Street 1:1083 N SALEM DR
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-1331
Practice Address - Country:US
Practice Address - Phone:847-755-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-004213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty