Provider Demographics
NPI:1306884077
Name:SOUTH HOLLAND PHYSICAL THERAPY & REHABILITATION, LTD.
Entity type:Organization
Organization Name:SOUTH HOLLAND PHYSICAL THERAPY & REHABILITATION, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:708-331-7555
Mailing Address - Street 1:900 E 162ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2471
Mailing Address - Country:US
Mailing Address - Phone:708-331-7555
Mailing Address - Fax:
Practice Address - Street 1:900 E 162ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2471
Practice Address - Country:US
Practice Address - Phone:708-331-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL446310Medicare ID - Type Unspecified