Provider Demographics
NPI:1366783797
Name:ACE THERAPY SERVICES OF ILLINOIS, INC.
Entity type:Organization
Organization Name:ACE THERAPY SERVICES OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LOVELEI
Authorized Official - Middle Name:CIARA
Authorized Official - Last Name:PEPITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-219-7308
Mailing Address - Street 1:10345 DEARLOVE RD
Mailing Address - Street 2:UNIT 102
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3666
Mailing Address - Country:US
Mailing Address - Phone:815-219-7308
Mailing Address - Fax:
Practice Address - Street 1:7105 VIRGINIA RD
Practice Address - Street 2:SUITE 10
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7985
Practice Address - Country:US
Practice Address - Phone:815-219-7308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-017839261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy