Active NPI
Thanongsak Sanluecha, PT
- Physical Therapist
- Berwyn, IL
National Provider Identifier
1366991390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.010721
- Practice address
- 7008 Cermak Rd
Berwyn, IL 60402-2151 - Phone
- (708) 795-7040
- Fax
- (708) 795-5664
- NPI assigned
- Oct 3, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.010721 | IL | Primary |
Addresses
Primary practice location
7008 Cermak Rd
Berwyn, IL 60402-2151
Mailing address
1751 S Naperville Rd
Suite 200
Wheaton, IL 60189-5896
Phone (630) 221-0200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.010721 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475452800000",
"number": "1366991390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1751 S NAPERVILLE RD",
"address_2": "SUITE 200",
"city": "WHEATON",
"state": "IL",
"postal_code": "601895896",
"telephone_number": "630-221-0200",
"fax_number": "224-232-5680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7008 CERMAK RD",
"city": "BERWYN",
"state": "IL",
"postal_code": "604022151",
"telephone_number": "708-795-7040",
"fax_number": "708-795-5664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANLUECHA",
"first_name": "THANONGSAK",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-03",
"last_updated": "2016-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.010721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.