MEDICARE: EMPOWERME REHABILITATION IL AGENCY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1043799083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERME REHABILITATION IL AGENCY, LLC

Provider Business Mailing Address
First Line	:	120 S CENTRAL AVE STE 1050
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1731
Country	:	US
Telephone Number	:	314-485-7979
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 W MORTON AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2626
Country	:	US
Telephone Number	:	217-245-2996
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANAKA DIAS
Credential	:
Telephone Number	:	314-485-7979

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	08/10/2018

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Directions to “EMPOWERME REHABILITATION IL AGENCY, LLC ” Practice Location

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