Provider Demographics
NPI:1134456007
Name:INDEPENDENCE PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:INDEPENDENCE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-638-8809
Mailing Address - Street 1:1397 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2951
Mailing Address - Country:US
Mailing Address - Phone:708-367-8050
Mailing Address - Fax:708-367-8051
Practice Address - Street 1:1397 MAIN ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-2951
Practice Address - Country:US
Practice Address - Phone:708-367-8050
Practice Address - Fax:708-367-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty