Provider Demographics
NPI:1649473034
Name:MORRISON PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MORRISON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:847-234-1656
Mailing Address - Street 1:500 N WESTERN AVE
Mailing Address - Street 2:202
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1954
Mailing Address - Country:US
Mailing Address - Phone:847-234-1656
Mailing Address - Fax:
Practice Address - Street 1:500 N WESTERN AVE
Practice Address - Street 2:202
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1954
Practice Address - Country:US
Practice Address - Phone:847-234-1656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210434Medicare ID - Type Unspecified