Provider Demographics
NPI:1851682363
Name:OPAL THERAPY SERVICES LLC.
Entity type:Organization
Organization Name:OPAL THERAPY SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TONIDO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-517-6489
Mailing Address - Street 1:7177 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2210
Mailing Address - Country:US
Mailing Address - Phone:773-517-6489
Mailing Address - Fax:847-674-9888
Practice Address - Street 1:7177 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2210
Practice Address - Country:US
Practice Address - Phone:773-517-6489
Practice Address - Fax:847-674-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.007617261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy