Provider Demographics
NPI:1699899104
Name:SOUTHWEST PHYSICAL THERAPY & REHABILITATION, LTD
Entity type:Organization
Organization Name:SOUTHWEST PHYSICAL THERAPY & REHABILITATION, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-499-4497
Mailing Address - Street 1:9735 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3614
Mailing Address - Country:US
Mailing Address - Phone:708-499-4497
Mailing Address - Fax:708-499-4597
Practice Address - Street 1:9735 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3614
Practice Address - Country:US
Practice Address - Phone:708-499-4497
Practice Address - Fax:708-499-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600051702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618548OtherBCBS PROVIDER NUMBER
IL211953Medicare PIN