NPIMap

Organization Active NPI

Third Eye Bliss PT 1 LLC

  • Physical Therapist
  • Bolingbrook, IL
National Provider Identifier
1114671971
Registry record updated Feb 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
THIRD EYE BLISS PT 1 LLC
Practice address
140 E Boughton Rd
Bolingbrook, IL 60440-2014
Phone
(312) 975-7045
NPI assigned
Feb 9, 2022
Last updated
Feb 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2022

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

Authorized official

Name
Sachin Haralkar
Title
Owner
Phone
(312) 975-7045

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

140 E Boughton Rd
Bolingbrook, IL 60440-2014

Mailing address

2268 Glouceston LN
Naperville, IL 60564-8476

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220624002132 IL Part B Supplier - Clinic/Group Practice 3870972672 Receives reassigned benefits from 11 practitioners
Practice locations: Bolingbrook, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1644364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1114671971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2268 GLOUCESTON LN",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 E BOUGHTON RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402014",
            "telephone_number": "312-975-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD EYE BLISS PT 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "HARALKAR",
        "authorized_official_first_name": "SACHIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-975-7045"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; 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.