Provider Demographics
NPI:1770162992
Name:RESIDENTIAL PHYSICAL THERAPY SERVICES
Entity type:Organization
Organization Name:RESIDENTIAL PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:PAMELA
Authorized Official - Last Name:BRITANICO
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:847-786-0123
Mailing Address - Street 1:9933 LAWLER AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3753
Mailing Address - Country:US
Mailing Address - Phone:847-786-0123
Mailing Address - Fax:
Practice Address - Street 1:9933 LAWLER AVE STE 105
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3753
Practice Address - Country:US
Practice Address - Phone:847-786-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty