Premier Physical Therapy PC
NPI 1336127117ActiveOrganization· Physical Therapist· Evergreen Park, IL
Physical Therapist in Evergreen Park, Illinois, registered in NPPES in January 2006. The authorized official on file is Krystal Nicole Vaughn, Credentialing Specialist. Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - physical/occupational therapy group in private practice.
Overview
| NPI | 1336127117 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 3, 2006 |
| Last updated in NPPES | Sep 17, 2024 |
| Certified by provider | Sep 17, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 070007675 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL); Part B Supplier - Physical/Occupational Therapy Group in Private Practice (IN) |
|---|
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