Provider Demographics
NPI:1457755167
Name:HEALING HANDS PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:HEALING HANDS PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-915-0950
Mailing Address - Street 1:8695 ARCHER AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1260
Mailing Address - Country:US
Mailing Address - Phone:708-915-0950
Mailing Address - Fax:
Practice Address - Street 1:8695 ARCHER AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1260
Practice Address - Country:US
Practice Address - Phone:708-915-0950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017865261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy