1497995237 NPI number — STILL WATER PHYSICAL THERAPY AND MASSAGE, LTD

Table of content: (NPI 1497995237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497995237 NPI number — STILL WATER PHYSICAL THERAPY AND MASSAGE, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STILL WATER PHYSICAL THERAPY AND MASSAGE, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497995237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 WAUKEGAN RD
Provider Second Line Business Mailing Address:
SUITE 255
Provider Business Mailing Address City Name:
BANNOCKBURN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-5514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-405-7611
Provider Business Mailing Address Fax Number:
847-405-7622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 WAUKEGAN RD
Provider Second Line Business Practice Location Address:
STE 255
Provider Business Practice Location Address City Name:
BANNOCKBURN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-5514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-405-7611
Provider Business Practice Location Address Fax Number:
847-405-7622
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
LEANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-405-7611

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070014262 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com