Organization
PENTAFIL PHYSICAL THERAPY SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS OLYMPHIA ROLDAN TESORO P.T. (PRESIDENT)
(630) 527-6370
Entity
Organization
Contact information
Practice address
790 ROYAL SAINT GEORGE DR, SUITE 105, NAPERVILLE, IL 60563-8955
(630) 527-6370
(630) 527-6374
Mailing address
790 ROYAL SAINT GEORGE DR, SUITE 105, NAPERVILLE, IL 60563-8955
(630) 527-6370
(630) 527-6374
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2215734
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/27/2007
Last updated
01/18/2008
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