Provider Demographics
NPI:1770525172
Name:NAPERVILLE PHYSICAL THERAPY CENTER P C
Entity type:Organization
Organization Name:NAPERVILLE PHYSICAL THERAPY CENTER P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DONOHUE
Authorized Official - Last Name:RACHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-369-1015
Mailing Address - Street 1:1240 IROQUOIS AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8540
Mailing Address - Country:US
Mailing Address - Phone:630-369-1015
Mailing Address - Fax:630-369-5015
Practice Address - Street 1:1240 IROQUOIS AVE STE 400
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8540
Practice Address - Country:US
Practice Address - Phone:630-369-1015
Practice Address - Fax:630-369-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-006798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-005610OtherSTATE LICENSE NUMBER
IL070-005610OtherSTATE LICENSE NUMBER