NPIMap

Organization Active NPI

Lake County Physical Therapy LLC

  • Physical Therapist
  • Mundelein, IL
National Provider Identifier
1851487581
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-006952 Issued in IL
Legal business name
LAKE COUNTY PHYSICAL THERAPY LLC
Practice address
511 E Hawley St
Mundelein, IL 60060-2419
Phone
(847) 543-7604
Fax
(847) 543-7605
NPI assigned
Oct 4, 2006
Last updated
Nov 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Authorized official

Name
Mr. Zubin S Tantra, P.T.NPI 1417040411
Title
President / Member
Phone
(847) 201-7612

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070-006952 IL Primary

Addresses

Primary practice location

511 E Hawley St
Mundelein, IL 60060-2419

Mailing address

511 E Hawley St
Mundelein, IL 60060-2419
Phone (847) 543-7604

Other identifiers 1

IdentifierTypeStateIssuer
04922918OtherILBLUE CROSS BLUE SHIELD PROVIDER ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324001472 IL Part B Supplier - Clinic/Group Practice 6901797166 Receives reassigned benefits from 4 practitioners
Practice locations: Mundelein, IL; Hoffman Estates, IL; Aurora, IL

National Provider Directory

National Provider Directory

Locations

100 N Atkinson Rd
Ste 205
Grayslake, IL 60030
Phone (847) 543-7604

1721 Moon Lake Blvd
Ste 105
Hoffman Estates, IL 60169
Phone (224) 653-9989

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1851487581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 E HAWLEY ST",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600602419",
            "telephone_number": "847-543-7604",
            "fax_number": "847-543-7605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 E HAWLEY ST",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600602419",
            "telephone_number": "847-543-7604",
            "fax_number": "847-543-7605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTY PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A",
        "authorized_official_last_name": "TANTRA",
        "authorized_official_first_name": "ZUBIN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT / MEMBER",
        "authorized_official_telephone_number": "847-201-7612",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-006952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD PROVIDER ID",
            "identifier": "04922918",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mundelein, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; 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.