Provider Demographics
NPI:1215956412
Name:MID CITY PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:MID CITY PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-961-6837
Mailing Address - Street 1:PO BOX 410577
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-0577
Mailing Address - Country:US
Mailing Address - Phone:312-961-6837
Mailing Address - Fax:866-208-9129
Practice Address - Street 1:1266 PINE VALLEY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-6614
Practice Address - Country:US
Practice Address - Phone:312-961-6837
Practice Address - Fax:866-208-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634403OtherBLUE CROSS BLUE SHIELD
IL210084Medicare ID - Type Unspecified
ILK-11127Medicare PIN
ILS96943Medicare UPIN
IL210008Medicare ID - Type UnspecifiedGROUP