Provider Demographics
NPI:1184879538
Name:COMPLEX THERAPY, LTD
Entity type:Organization
Organization Name:COMPLEX THERAPY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYBA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-439-5445
Mailing Address - Street 1:105 N HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-2459
Mailing Address - Country:US
Mailing Address - Phone:630-439-5445
Mailing Address - Fax:224-333-0589
Practice Address - Street 1:105 N HUBBARD ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-2459
Practice Address - Country:US
Practice Address - Phone:630-439-5445
Practice Address - Fax:224-333-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010895261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01627658OtherBC/BS