Provider Demographics
NPI:1285726554
Name:ADVANCED CARE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:ADVANCED CARE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASILNIOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-673-4800
Mailing Address - Street 1:9416 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1311
Mailing Address - Country:US
Mailing Address - Phone:847-673-4800
Mailing Address - Fax:847-673-9322
Practice Address - Street 1:9416 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1311
Practice Address - Country:US
Practice Address - Phone:847-673-4800
Practice Address - Fax:847-673-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
01632553OtherBC BS
200942Medicare ID - Type Unspecified