MEDICARE: FLEXEON REHABILITATION OF CEDAR LAKE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1063610640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLEXEON REHABILITATION OF CEDAR LAKE, LLC

Provider Business Mailing Address
First Line	:	13019 WICKER AVE
Second Line	:	STE A
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-9345
Country	:	US
Telephone Number	:	219-374-5451
Fax Number	:	219-374-5512

Provider Business Practice Location Address
First Line	:	13019 WICKER AVE
Second Line	:	STE A
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-9345
Country	:	US
Telephone Number	:	219-374-5451
Fax Number	:	219-374-5512

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES JUDGE
Credential	:	PT
Telephone Number	:	219-922-9508

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	11/22/2010

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