Organization
PREMIUM PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EYAEMA EKENG AANAMNDU (EXECUTIVE DIRECTOR)
(708) 957-3300
Entity
Organization
Contact information
Practice address
17901 GOVERNORS HWY, SUITE 204, HOMEWOOD, IL 60430-1144
(708) 957-3300
(708) 957-3385
Mailing address
17065 DIXIE HWY, SUITE 24, HAZEL CREST, IL 60429-1376
(708) 957-3300
(708) 957-3385
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/23/2007
Last updated
08/22/2020
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