Organization
FUNCTIONAL PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM FRANCIS FEDORSKI PT, ATC (PRESIDENT/OWNER)
(630) 893-5534
Entity
Organization
Contact information
Practice address
369 W ARMY TRAIL RD, UNIT 14, BLOOMINGDALE, IL 60108-2358
(630) 893-5534
(630) 893-5527
Mailing address
152 S BLOOMINGDALE RD, UNIT 101, BLOOMINGDALE, IL 60108-1481
(630) 893-5534
(630) 893-5527
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-011136
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02232938
BLUE CROSS BLUE SHIELD
IL
05
—
352586282001
—
IL
01
—
DH0131
RAILROAD MEDICARE
IL
01
—
P00478856
RAILROAD MEDICARE
IL
Enumeration date
05/17/2006
Last updated
07/13/2011
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