Provider Demographics
NPI:1447808712
Name:AVAYA THERAPY, LTD
Entity type:Organization
Organization Name:AVAYA THERAPY, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:PACIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-463-3700
Mailing Address - Street 1:10700 W HIGGINS ROAD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-3729
Mailing Address - Country:US
Mailing Address - Phone:847-324-3434
Mailing Address - Fax:
Practice Address - Street 1:10700 W HIGGINS ROAD
Practice Address - Street 2:SUITE 340
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-3729
Practice Address - Country:US
Practice Address - Phone:847-324-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty