Provider Demographics
NPI:1013057397
Name:ORTHOPEDIC & SPINE SURGERY ASSOC.
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINE SURGERY ASSOC.
Other - Org Name:ROYAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-931-5300
Mailing Address - Street 1:2350 ROYAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-931-5300
Mailing Address - Fax:847-931-9072
Practice Address - Street 1:2971 W ALGONQUIN RD
Practice Address - Street 2:#101B
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9406
Practice Address - Country:US
Practice Address - Phone:847-854-8840
Practice Address - Fax:847-854-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207906Medicare ID - Type UnspecifiedMCHENRY COUNTY