Provider Demographics
NPI:1427060706
Name:PRES PHYSICAL THERAPY
Entity type:Organization
Organization Name:PRES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:SATYA
Authorized Official - Last Name:BHOGARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-837-2705
Mailing Address - Street 1:874 S IL ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1633
Mailing Address - Country:US
Mailing Address - Phone:630-837-2705
Mailing Address - Fax:630-837-2686
Practice Address - Street 1:874 S IL ROUTE 59
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-1633
Practice Address - Country:US
Practice Address - Phone:630-837-2705
Practice Address - Fax:630-837-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy