Provider Demographics
NPI:1801957055
Name:PHYSIOTHERAPY PROFESSIONALS LLC
Entity type:Organization
Organization Name:PHYSIOTHERAPY PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:217-546-3301
Mailing Address - Street 1:2921 GREENBRIAR DR
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6421
Mailing Address - Country:US
Mailing Address - Phone:217-546-3301
Mailing Address - Fax:217-546-3302
Practice Address - Street 1:2921 GREENBRIAR DR
Practice Address - Street 2:SUITE B-2
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6421
Practice Address - Country:US
Practice Address - Phone:217-546-3301
Practice Address - Fax:217-546-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215067Medicare UPIN