Provider Demographics
NPI:1922177633
Name:HORIZON PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:HORIZON PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ATEF
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:773-884-0100
Mailing Address - Street 1:6441 S. PULASKI RD.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629
Mailing Address - Country:US
Mailing Address - Phone:773-884-0100
Mailing Address - Fax:773-884-0800
Practice Address - Street 1:6441 S PULASKI RD
Practice Address - Street 2:SUITE 306
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5148
Practice Address - Country:US
Practice Address - Phone:773-884-0100
Practice Address - Fax:773-884-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635585OtherBCBS
IL212618Medicare ID - Type Unspecified