Organization
BUFFALO GROVE PHYSICAL THERAPY AND SPORTS REHABILITATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GOPAL TERALANDUR RAGHUNATH MSPT DPT CSPT (OWNER)
(847) 564-1349
Entity
Organization
Contact information
Practice address
125 EAST LAKE COOK RD, SUITE 209, BUFFALO GROVE, IL 60089
(847) 520-3382
(847) 520-3404
Mailing address
125 EAST LAKE COOK RD, SUITE 209, BUFFALO GROVE, IL 60089
(847) 520-3382
(847) 520-3404
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070013042
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01617203
BLUE CROSS BLUE SHIELD
IL
Enumeration date
04/04/2007
Last updated
07/15/2008
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