Provider Demographics
NPI:1922186139
Name:HINSDALE SPORT AND SPINE THERAPY
Entity Type:Organization
Organization Name:HINSDALE SPORT AND SPINE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:708-601-1728
Mailing Address - Street 1:1 E OAKHILL DR STE 400
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5540
Mailing Address - Country:US
Mailing Address - Phone:630-455-1723
Mailing Address - Fax:630-455-1865
Practice Address - Street 1:1 E OAKHILL DR STE 400
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5540
Practice Address - Country:US
Practice Address - Phone:630-455-1723
Practice Address - Fax:630-455-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2023-06-26
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
IL209675Medicare PIN