Provider Demographics
NPI:1558895797
Name:HUNTLEY PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:HUNTLEY PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-893-8480
Mailing Address - Street 1:530 ROCKLAND RD
Mailing Address - Street 2:STE 500
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4131
Mailing Address - Country:US
Mailing Address - Phone:815-893-8480
Mailing Address - Fax:815-893-8481
Practice Address - Street 1:10395 VINE ST
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9589
Practice Address - Country:US
Practice Address - Phone:815-893-8480
Practice Address - Fax:815-893-8481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016104261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy