Provider Demographics
NPI:1992834014
Name:PHYSICAL THERAPY CARE
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:SAMWEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHNOUKH
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:708-425-2345
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-425-2345
Mailing Address - Fax:708-425-3456
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-425-2345
Practice Address - Fax:708-425-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
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 - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL338865266001Medicaid
IL338865266001Medicaid