Provider Demographics
NPI:1316262926
Name:POPLAR GROVE PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:POPLAR GROVE PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRZYMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-221-6717
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0150
Mailing Address - Country:US
Mailing Address - Phone:419-221-6717
Mailing Address - Fax:815-234-5870
Practice Address - Street 1:13526 JULIE DR
Practice Address - Street 2:
Practice Address - City:POPLAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:61065-7829
Practice Address - Country:US
Practice Address - Phone:815-765-1155
Practice Address - Fax:815-765-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty