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NPI Code Detail

MEDICARE: JACOB'S LADDER PEDIATRIC REHAB CENTER

MEDICARE: JACOB'S LADDER PEDIATRIC REHAB CENTER
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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265519151
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACOB'S LADDER PEDIATRIC REHAB CENTER
Provider Business Mailing Address
First Line : 1595 S CALUMET RD STE 3
Second Line :
City : CHESTERTON
State : IN
Zip : 46304-2389
Country : US
Telephone Number : 219-764-4888
Fax Number : 219-764-4805
Provider Business Practice Location Address
First Line : 1595 S CALUMET RD STE 3
Second Line :
City : CHESTERTON
State : IN
Zip : 46304-2389
Country : US
Telephone Number : 219-763-6858
Fax Number : 219-763-4858
Authorized Official
Title or Position : DIRECTOR OF ADMIN OPERATIONS
Name : MRS. TRACY HALL
Credential :
Telephone Number : 219-250-3203
Provider Enumeration Date : 10/31/2006
Last Update Date : 03/04/2025

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Directions to “JACOB'S LADDER PEDIATRIC REHAB CENTER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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