NPIMap

Organization Active NPI

Functional Health and Wellness

  • Physical Therapy Clinic/Center
  • Oak Park, IL
National Provider Identifier
1275775421
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
FUNCTIONAL HEALTH AND WELLNESS
Practice address
852 Madison St
Oak Park, IL 60302-4441
Phone
(708) 445-3965
Fax
(708) 445-1355
NPI assigned
Apr 2, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Authorized official

Name
Ryan C Todd, PT, DPTNPI 1174564744
Title
Owner
Phone
(708) 445-3965

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Geriatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251G0304X
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X 070013594 IL
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

852 Madison St
Oak Park, IL 60302-4441

Mailing address

852 Madison St
Oak Park, IL 60302-4441
Phone (708) 445-3965

Other names 1

  • FYZICAL Therapy and Balance Center of South Oak Park Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090522000491 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6608925565 Receives reassigned benefits from 3 practitioners
Practice locations: Oak Park, IL

National Provider Directory

National Provider Directory

Locations

1042 Pleasant St
Oak Park, IL 60302
Phone (630) 417-3044

Practitioners & affiliated clinicians

Practitioners 4

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": "1238630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665360000000",
    "number": "1275775421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 MADISON ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603024441",
            "telephone_number": "708-445-3965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "852 MADISON ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603024441",
            "telephone_number": "708-445-3965",
            "fax_number": "708-445-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL HEALTH AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-02",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A",
        "authorized_official_last_name": "TODD",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-445-3965",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": "070013594",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FYZICAL Therapy and Balance Center of South Oak Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oak Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.