Provider Demographics
NPI:1962679290
Name:SPECKMAN THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:SPECKMAN THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-553-6888
Mailing Address - Street 1:88 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9046
Mailing Address - Country:US
Mailing Address - Phone:630-553-6888
Mailing Address - Fax:
Practice Address - Street 1:88 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9046
Practice Address - Country:US
Practice Address - Phone:630-553-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007763261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4732110OtherBLUE CROSS BLUE SHIELD ILLINOIS
IL216812Medicare PIN