Provider Demographics
NPI:1154571685
Name:COLETTE A SIPPEL PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:COLETTE A SIPPEL PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-385-1981
Mailing Address - Street 1:60 PELICAN BAY
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-4726
Mailing Address - Country:US
Mailing Address - Phone:847-385-1981
Mailing Address - Fax:847-859-5896
Practice Address - Street 1:1320 TOWER RD
Practice Address - Street 2:SUITE 105 AND 106
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4309
Practice Address - Country:US
Practice Address - Phone:847-385-1981
Practice Address - Fax:847-859-5896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-20
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1294Medicare PIN