NPIMap

Organization Active NPI

Impact Physical Therapy, LLC

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1508622614
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
IMPACT PHYSICAL THERAPY, LLC
Practice address
1103 S State St Ste 300
Chicago, IL 60605-2775
Phone
(312) 877-5101
Fax
(312) 877-5906
NPI assigned
Feb 26, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Denise M Deasy
Title
HR Director
Phone
(630) 399-1015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1103 S State St Ste 300
Chicago, IL 60605-2775

Mailing address

PO Box 220
Westmont, IL 60559-0220
Phone (708) 590-6663

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240726001923 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2466998398 Receives reassigned benefits from 44 practitioners
Practice locations: Chicago, IL; Orland Park, IL; Oak Lawn, IL; Naperville, IL; Hinsdale, IL; Champaign, IL

National Provider Directory

National Provider Directory

Locations

602 S Neil St
Champaign, IL 61820
Phone (217) 649-0504

3420 N Lincoln Ave
Chicago, IL 60657
Phone (773) 360-7287

1103 S State St
Ste 300
Chicago, IL 60605
Phone (312) 877-5101

10412 S Cicero Ave
Oak Lawn, IL 60453

Practitioners & affiliated clinicians

Practitioners 63

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.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1508622614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605590220",
            "telephone_number": "708-590-6663",
            "fax_number": "709-469-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 S STATE ST STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052775",
            "telephone_number": "312-877-5101",
            "fax_number": "312-877-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "DEASY",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "HR DIRECTOR",
        "authorized_official_telephone_number": "630-399-1015"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.