Organization
DOC'S PT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD BRYANT COLOSI DPT, FAFS, FMR (PRESIDENT)
(847) 542-4868
Entity
Organization
Contact information
Practice address
1211 WASHINGTON AVE, WILMETTE, IL 60091-2520
(847) 542-4868
Mailing address
1898 MCRAE LN, MUNDELEIN, IL 60060-1468
(847) 542-4868
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
070014101
IL
Other
Enumeration date
08/09/2012
Last updated
08/09/2012
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