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Organization
PREMIUM PT SOLUTIONS LLC
Active
Organization
PREMIUM PT SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE TUCKER (DIRECTOR)
(630) 755-4327
Entity
Organization
Contact information
Practice address
16137 LA SALLE ST, SOUTH HOLLAND, IL 60473-2064
(708) 571-3330
(708) 571-3435
Mailing address
2625 BUTTERFIELD RD STE 219S, OAK BROOK, IL 60523-1239
(630) 755-4327
(630) 819-8153
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
01/04/2019
Last updated
01/04/2019
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