Healthcare Provider Details

I. General information

NPI: 1548251747
Provider Name (Legal Business Name): NW REHAB, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E CENTER DR
ALTON IL
62002-5931
US

IV. Provider business mailing address

233 E CENTER DR
ALTON IL
62002-5931
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-7717
  • Fax: 618-465-7710
Mailing address:
  • Phone: 618-465-7717
  • Fax: 618-465-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. J. TERRY DOOLING
Title or Position: MEMBER
Credential: C.P.A.
Phone: 618-465-7717