Basic Information
| Provider Information | |||||||||
| NPI: | 1811991235 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERASYS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 NEWPORT DR | ||||||||
| Address2: | STE 401 | ||||||||
| City: | ROLLING MEADOWS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600083840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477971050 | ||||||||
| FaxNumber: | 8477971337 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 W NORTHWEST HWY | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600671837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473582225 | ||||||||
| FaxNumber: | 8473588354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CORNETT | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN OF THE BOARD | ||||||||
| AuthorizedOfficialTelephone: | 8476316235 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.