Provider Demographics
NPI:1487606455
Name:UPRIGHT PHYSICAL THERAPY AND REHABILITATION, PC.
Entity type:Organization
Organization Name:UPRIGHT PHYSICAL THERAPY AND REHABILITATION, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEMENTINA
Authorized Official - Middle Name:NKECHI
Authorized Official - Last Name:SOLOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:773-233-7800
Mailing Address - Street 1:3013 HERMES DR
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1468
Mailing Address - Country:US
Mailing Address - Phone:773-233-7800
Mailing Address - Fax:773-233-7808
Practice Address - Street 1:1402 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2953
Practice Address - Country:US
Practice Address - Phone:773-233-7800
Practice Address - Fax:773-233-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9437883OtherPRIVATE HEALTHCARE SYSTEM
IL351921204001Medicaid
IL351921204001Medicaid
IL209372Medicare UPIN
IL2732361Medicare UPIN
IL7618603Medicare UPIN
IL01634384Medicare UPIN