# FUNCTIONAL PHYSICAL THERAPY, INC

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

## Provider details

- **NPI number:** 1790738409
- **Authorized official:** TIM FRANCIS FEDORSKI PT, ATC (PRESIDENT/OWNER)
- **Authorized official phone:** (630) 893-5534

## Contact information

- **Practice address:** 369 W ARMY TRAIL RD, UNIT 14, BLOOMINGDALE, IL 60108-2358
- **Practice address phone:** (630) 893-5534
- **Practice address fax:** (630) 893-5527
- **Mailing address:** 152 S BLOOMINGDALE RD, UNIT 101, BLOOMINGDALE, IL 60108-1481
- **Mailing address phone:** (630) 893-5534
- **Mailing address fax:** (630) 893-5527

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 070-011136 | IL | Yes |

## Other

- **Enumeration date:** 05/17/2006
- **Last updated:** 07/13/2011