Provider Demographics
NPI:1649727900
Name:SUPPLEMENTAL THERAPY SERVICES INC
Entity type:Organization
Organization Name:SUPPLEMENTAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIR GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:708-359-2670
Mailing Address - Street 1:3309 CUMBERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1120
Mailing Address - Country:US
Mailing Address - Phone:708-365-8158
Mailing Address - Fax:
Practice Address - Street 1:3309 CUMBERLAND TRL
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1120
Practice Address - Country:US
Practice Address - Phone:708-365-8158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-04
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy