Healthcare Provider Details

I. General information

NPI: 1497012157
Provider Name (Legal Business Name): ELITE REHAB ADDISON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W ARMY TRAIL BLVD SUITE A
ADDISON IL
60101-3299
US

IV. Provider business mailing address

601 W ARMY TRAIL RD SUITE A
ADDISON IL
60101-3299
US

V. Phone/Fax

Practice location:
  • Phone: 630-501-0971
  • Fax: 630-501-1789
Mailing address:
  • Phone: 630-501-0971
  • Fax: 630-501-1789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANTHONY M PIRIE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 630-501-0971