NPIMap

Organization Active NPI

Buffalo Grove Physical Therapy and Sports Rehabilitation PC

  • Physical Therapist
  • Buffalo Grove, IL
National Provider Identifier
1235251026
Registry record updated Jul 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070013042 Issued in IL
Legal business name
BUFFALO GROVE PHYSICAL THERAPY AND SPORTS REHABILITATION PC
Practice address
125 East Lake Cook Rd
Suite 209
Buffalo Grove, IL 60089
Phone
(847) 520-3382
Fax
(847) 520-3404
NPI assigned
Apr 4, 2007
Last updated
Jul 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2008

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

Authorized official

Name
Mr. Gopal Teralandur Raghunath, MSPT DPT CSPTNPI 1073635777
Title
Owner
Phone
(847) 564-1349

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070013042 IL Primary

Addresses

Primary practice location

125 East Lake Cook Rd
Suite 209
Buffalo Grove, IL 60089

Mailing address

125 East Lake Cook Rd
Suite 209
Buffalo Grove, IL 60089
Phone (847) 520-3382

Other identifiers 1

IdentifierTypeStateIssuer
01617203OtherILBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

125 E Lake Cook Rd
Ste 209
Buffalo Grove, IL 60089
Phone (847) 520-3382

Practitioners & affiliated clinicians

Practitioners 3

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": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216080000000",
    "number": "1235251026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 EAST LAKE COOK RD",
            "address_2": "SUITE 209",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "60089",
            "telephone_number": "847-520-3382",
            "fax_number": "847-520-3404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 EAST LAKE COOK RD",
            "address_2": "SUITE 209",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "60089",
            "telephone_number": "847-520-3382",
            "fax_number": "847-520-3404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUFFALO GROVE PHYSICAL THERAPY AND SPORTS REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2008-07-15",
        "status": "A",
        "authorized_official_last_name": "RAGHUNATH",
        "authorized_official_first_name": "GOPAL",
        "authorized_official_middle_name": "TERALANDUR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-564-1349",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPT DPT CSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070013042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01617203",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; 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.