Basic Information
| Provider Information | |||||||||
| NPI: | 1760437180 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERASYS CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 NEWPORT DR | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | ROLLING MEADOWS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600083832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476316227 | ||||||||
| FaxNumber: | 8477971337 | ||||||||
| Practice Location | |||||||||
| Address1: | 10751 163RD PL | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604678861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083493377 | ||||||||
| FaxNumber: | 7083497430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAUGH | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8476316227 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CFO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 01635363 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER |