Provider Demographics
NPI:1649318833
Name:PHYSICAL THERAPY REHAB OF ILLINOIS INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY REHAB OF ILLINOIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:630-639-1153
Mailing Address - Street 1:1S132 SUMMIT AVE
Mailing Address - Street 2:STE. #108
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3955
Mailing Address - Country:US
Mailing Address - Phone:630-261-0727
Mailing Address - Fax:630-261-0716
Practice Address - Street 1:205 E BUTTERFIELD RD
Practice Address - Street 2:STE. #154
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5103
Practice Address - Country:US
Practice Address - Phone:630-639-1153
Practice Address - Fax:630-261-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232534OtherBCBS OF IL PROVIDER #
IL02232534OtherBCBS OF IL PROVIDER #
ILIL1844Medicare PIN