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Organization
ORTHO-SPORT, INC.
Active
Organization
ORTHO-SPORT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL EDWARD KEENUM PT (OWNER PRESIDENT)
(708) 366-2442
Entity
Organization
Contact information
Practice address
800 DES PLAINES AVE, FOREST PARK, IL 60130-2035
(708) 366-2442
(708) 366-0179
Mailing address
800 DES PLAINES AVE, FOREST PARK, IL 60130-2035
(708) 366-2442
(708) 366-0179
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1683317
BCBS OF IL
IL
Enumeration date
11/06/2006
Last updated
08/22/2020
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