Basic Information
| Provider Information | |||||||||
| NPI: | 1578615225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL THERAPY SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2810 FRANK SCOTT PKWY W | ||||||||
| Address2: | SUITE 824 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622235007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182349705 | ||||||||
| FaxNumber: | 6182570665 | ||||||||
| Practice Location | |||||||||
| Address1: | 2988 COURT ST | ||||||||
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| City: | PEKIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615546229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093535940 | ||||||||
| FaxNumber: | 3093531654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 02/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | RILEY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6182349705 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8215184 | 01 | IL | IL BLUE CROSS BLUE SHIELD | OTHER | 172753 | 01 | IL | HEALTHLINK PROVIDER NUMBE | OTHER | C4776 | 01 | IL | RAILROAD MEDICARE | OTHER |