NPIMap

Organization Active NPI

TCM Physical Therapy, Inc.

  • Pediatric Physical Therapist
  • Crystal Lake, IL
National Provider Identifier
1093085060
Registry record updated Jan 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
070.007032 Issued in IL
Legal business name
TCM PHYSICAL THERAPY, INC.
Practice address
4421 S Nancy Dr
Crystal Lake, IL 60014-6464
Phone
(815) 245-3845
NPI assigned
Jan 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2012

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

Authorized official

Name
Connie MyjakNPI 1619048071
Title
President
Phone
(815) 245-3845

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251P0200X 070.007032 IL Primary

Addresses

Primary practice location

4421 S Nancy Dr
Crystal Lake, IL 60014-6464

Mailing address

4421 S Nancy Dr
Crystal Lake, IL 60014-6464
Phone (815) 245-3845

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1326067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326067200000",
    "number": "1093085060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4421 S NANCY DR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146464",
            "telephone_number": "815-245-3845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4421 S NANCY DR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146464",
            "telephone_number": "815-245-3845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TCM PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-09",
        "last_updated": "2012-01-09",
        "status": "A",
        "authorized_official_last_name": "MYJAK",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-245-3845"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "IL",
            "license": "070.007032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.