Provider Demographics
NPI:1548446370
Name:POTDUKHE, VILAS (PT)
Entity type:Individual
Prefix:MR
First Name:VILAS
Middle Name:
Last Name:POTDUKHE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 HILLCREST LN
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7552
Mailing Address - Country:US
Mailing Address - Phone:630-985-2766
Mailing Address - Fax:
Practice Address - Street 1:23909 W RENWICK RD
Practice Address - Street 2:SUITE # 101
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2108
Practice Address - Country:US
Practice Address - Phone:815-577-8990
Practice Address - Fax:815-577-8995
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist