# GOODLIFE PHYSICAL THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053557264
- **Authorized official:** DR. MIRAB MICKEY SHAH PT (PHYSICAL THERAPIST)
- **Authorized official phone:** (708) 966-4386

## Contact information

- **Practice address:** 16517 106TH CT, ORLAND PARK, IL 60467-4545
- **Practice address phone:** (708) 966-4386
- **Practice address fax:** (708) 966-4387
- **Mailing address:** 9730 S WESTERN AVE, EVERGREEN PARK, IL 60805-2814
- **Mailing address phone:** (708) 581-9700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 070-013727 | IL | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 12/18/2008
- **Last updated:** 08/01/2024