Provider Demographics
NPI:1679397442
Name:COMMUNITY PHYSICAL THERAPY & ASSOCIATES LTD
Entity type:Organization
Organization Name:COMMUNITY PHYSICAL THERAPY & ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:708-969-7919
Mailing Address - Street 1:2171 W EXECUTIVE DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-5626
Mailing Address - Country:US
Mailing Address - Phone:630-766-0505
Mailing Address - Fax:
Practice Address - Street 1:2171 W EXECUTIVE DR STE 500
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5626
Practice Address - Country:US
Practice Address - Phone:630-766-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation