Illinois Mobile Therapy Group LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070019896 Issued in IL

Legal business name

ILLINOIS MOBILE THERAPY GROUP LLC

Practice address

1750 E 87TH St Ste 103
Chicago, IL 60617-2706

Phone

(800) 618-6612

Fax

(708) 218-9112

NPI assigned

Aug 28, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Idris Omosanya, PT, DPT

Title

Physical Therapist

Phone

(708) 268-0862

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1377648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551139200000",
    "number": "1235563073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E 87TH ST STE 103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606172706",
            "telephone_number": "800-618-6612",
            "fax_number": "708-218-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E 87TH ST STE 103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606172706",
            "telephone_number": "800-618-6612",
            "fax_number": "708-218-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS MOBILE THERAPY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-28",
        "last_updated": "2019-02-26",
        "status": "A",
        "authorized_official_last_name": "OMOSANYA",
        "authorized_official_first_name": "IDRIS",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "708-268-0862",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070019896",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056005754",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Illinois Medical Care and Consulting, LLC
• Illinois Medical Care LTD
• Illinois Medical Group SC
• Illinois Medical Specialists PC
• Illinois Mobile Foot Care LLC
• Illinois Orthopedic Network, LLC
• Illinois Pain and Therapy Associates Inc.
• Illinois Pain Management S C
• Illinois Pharmacy Management, LLC
• Illinois Physicians Alliance, LLC

• Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; 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.