# PREMIUM PT SOLUTIONS LLC

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

## Provider details

- **NPI number:** 1538632393
- **Authorized official:** STEPHANIE TUCKER (DIRECTOR)
- **Authorized official phone:** (630) 755-4327

## Contact information

- **Practice address:** 16137 LA SALLE ST, SOUTH HOLLAND, IL 60473-2064
- **Practice address phone:** (708) 571-3330
- **Practice address fax:** (708) 571-3435
- **Mailing address:** 2625 BUTTERFIELD RD STE 219S, OAK BROOK, IL 60523-1239
- **Mailing address phone:** (630) 755-4327
- **Mailing address fax:** (630) 819-8153

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/04/2019
- **Last updated:** 01/04/2019