MEDICARE: THE REHABILITATION AND PAIN MANAGEMENT INSTITUE, SC

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	:	1275654097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE REHABILITATION AND PAIN MANAGEMENT INSTITUE, SC

Provider Business Mailing Address
First Line	:	2320 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-5242
Country	:	US
Telephone Number	:	773-508-9800
Fax Number	:	773-508-1796

Provider Business Practice Location Address
First Line	:	2320 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-5242
Country	:	US
Telephone Number	:	773-508-9800
Fax Number	:	773-508-1796

Authorized Official
Title or Position	:	COO
Name	:	MR. ROGER GOMEZ
Credential	:
Telephone Number	:	773-508-9800

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/22/2020

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