NPIMap

Organization Active NPI

Goodlife Physical Therapy

  • Physical Therapist
  • Orland Park, IL
National Provider Identifier
1053557264
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-013727 Issued in IL
Legal business name
GOODLIFE PHYSICAL THERAPY
Practice address
16517 106TH CT
Orland Park, IL 60467-4545
Phone
(708) 966-4386
Fax
(708) 966-4387
NPI assigned
Dec 18, 2008
Last updated
Aug 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mirab Mickey Shah, PTNPI 1902079981
Title
Physical Therapist
Phone
(708) 966-4386

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU
Physical Therapist 225100000X 070-013727 IL Primary

Addresses

Primary practice location

16517 106TH CT
Orland Park, IL 60467-4545

Mailing address

9730 S Western Ave
Evergreen Park, IL 60805-2814
Phone (708) 581-9700

Other practice location 1

14753 Founders Xing
Homer Glen, IL 60491-6716
Phone (708) 645-7700

Other practice location 2

9730 S Western Ave
Evergreen Park, IL 60805-2814
Phone (708) 581-9700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101202000593 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6608924865 Receives reassigned benefits from 11 practitioners
Practice locations: Orland Park, IL; Evergreen Park, IL; Homer Glen, IL

National Provider Directory

National Provider Directory

Locations

5331 135th St
Crestwood, IL 60418
Phone (708) 966-4386

9730 S Western Ave
Ste 240
Evergreen Park, IL 60805
Phone (708) 581-9700

9730 S Western Ave
Evergreen Pk, IL 60805
Phone (708) 423-8833

14753 Founders Xing
Homer Glen, IL 60491
Phone (708) 645-7700

806 Arlington Ave
Lagrange Hlds, IL 60525
Phone (708) 247-0826

16618 W 159th St
Ste 402
Lockport, IL 60441
Phone (815) 838-0529

16517 106th Ct
Orland Park, IL 60467
Phone (708) 966-4386

9721 165th St
Ste 25
Orland Park, IL 60467
Phone (630) 789-3764

7700 Graphics Dr
Tinley Park, IL 60477
Phone (708) 468-4270

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1053557264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9730 S WESTERN AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052814",
            "telephone_number": "708-581-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16517 106TH CT",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604674545",
            "telephone_number": "708-966-4386",
            "fax_number": "708-966-4387"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14753 Founders Xing",
            "address_purpose": "LOCATION",
            "city": "Homer Glen",
            "state": "IL",
            "postal_code": "604916716",
            "country_code": "US",
            "telephone_number": "708-645-7700",
            "fax_number": "708-645-7702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9730 S Western Ave",
            "address_purpose": "LOCATION",
            "city": "Evergreen Park",
            "state": "IL",
            "postal_code": "608052814",
            "country_code": "US",
            "telephone_number": "708-581-9700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GOODLIFE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-18",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "MIRAB",
        "authorized_official_middle_name": "MICKEY",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "708-966-4386",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-013727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.