Provider Demographics
NPI:1770803686
Name:BARRINGTON REHABILITATION AND SPORTS PHYSICAL THERAPY
Entity type:Organization
Organization Name:BARRINGTON REHABILITATION AND SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-381-8812
Mailing Address - Street 1:27401 W IL ROUTE 22
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5999
Mailing Address - Country:US
Mailing Address - Phone:847-381-8812
Mailing Address - Fax:847-381-6311
Practice Address - Street 1:27401 W IL ROUTE 22
Practice Address - Street 2:SUITE 107
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5999
Practice Address - Country:US
Practice Address - Phone:847-381-8812
Practice Address - Fax:847-381-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056001363225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4831690001Medicare NSC
IL210814Medicare PIN