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Organization
ILLINOIS MOBILE THERAPY GROUP LLC
Active
Organization
ILLINOIS MOBILE THERAPY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IDRIS OMOSANYA PT, DPT (PHYSICAL THERAPIST)
(708) 268-0862
Entity
Organization
Contact information
Practice address
1750 E 87TH ST STE 103, CHICAGO, IL 60617-2706
(800) 618-6612
(708) 218-9112
Mailing address
1750 E 87TH ST STE 103, CHICAGO, IL 60617-2706
(800) 618-6612
(708) 218-9112
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070019896
IL
225X00000X
Occupational Therapist
056005754
IL
Other
Enumeration date
08/28/2013
Last updated
02/26/2019
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