Provider Demographics
NPI:1609801596
Name:PRINCETON PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:PRINCETON PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:COURI
Authorized Official - Last Name:BEHRENDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-875-4441
Mailing Address - Street 1:200 ACE ROAD STE 2
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356
Mailing Address - Country:US
Mailing Address - Phone:815-875-4441
Mailing Address - Fax:815-875-7732
Practice Address - Street 1:200 ACE RD STE 2
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356
Practice Address - Country:US
Practice Address - Phone:815-875-4441
Practice Address - Fax:815-875-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210817Medicare ID - Type Unspecified