NPIMap

Organization Active NPI

Orland Physical Therapy LTD

  • Physical Therapist
  • Orland Park, IL
National Provider Identifier
1104306315
Registry record updated Aug 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070020007 Issued in IL
Legal business name
ORLAND PHYSICAL THERAPY LTD
Practice address
14640 John Humphrey Dr Ste 102
Orland Park, IL 60462-5852
Phone
(708) 227-2771
NPI assigned
Aug 16, 2018
Last updated
Aug 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2018

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

Authorized official

Name
Justin W Bergmann, DPTNPI 1417374190
Title
President
Phone
(708) 227-2771

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
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 070020007 IL Primary

Addresses

Primary practice location

14640 John Humphrey Dr Ste 102
Orland Park, IL 60462-5852

Mailing address

7513 Dorothy LN
Tinley Park, IL 60477-2447
Phone (708) 227-2771

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180926002564 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4284985409 Receives reassigned benefits from 5 practitioners
Practice locations: Orland Park, IL

National Provider Directory

National Provider Directory

Locations

14640 John Humphrey Dr
Ste 102
Orland Park, IL 60462
Phone (708) 227-2771

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1534377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534377600000",
    "number": "1104306315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7513 DOROTHY LN",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772447",
            "telephone_number": "708-227-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14640 JOHN HUMPHREY DR STE 102",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604625852",
            "telephone_number": "708-227-2771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORLAND PHYSICAL THERAPY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-16",
        "last_updated": "2018-08-16",
        "status": "A",
        "authorized_official_last_name": "BERGMANN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-227-2771",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070020007",
            "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 16, 2018; 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.