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Organization

ILLINOIS MOBILE THERAPY GROUP LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. IDRIS OMOSANYA PT, DPT (PHYSICAL THERAPIST)
(708) 268-0862
Entity
Organization

Contact information

Practice address
1750 E 87TH ST STE 103, CHICAGO, IL 60617-2706
(800) 618-6612
(708) 218-9112
Mailing address
1750 E 87TH ST STE 103, CHICAGO, IL 60617-2706
(800) 618-6612
(708) 218-9112

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070019896
IL
225X00000X
Occupational Therapist
056005754
IL

Other

Enumeration date
08/28/2013
Last updated
02/26/2019
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