Provider Demographics
NPI:1538617493
Name:TOTAL BODY PHYSICAL THERAPY SC
Entity type:Organization
Organization Name:TOTAL BODY PHYSICAL THERAPY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-587-5824
Mailing Address - Street 1:1121 E MAIN ST
Mailing Address - Street 2:240
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2205
Mailing Address - Country:US
Mailing Address - Phone:630-587-5824
Mailing Address - Fax:630-587-5834
Practice Address - Street 1:1121 E MAIN ST
Practice Address - Street 2:240
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2205
Practice Address - Country:US
Practice Address - Phone:630-587-5824
Practice Address - Fax:630-587-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020447261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1508181728Medicare PIN