Healthcare Provider Details

I. General information

NPI: 1336497940
Provider Name (Legal Business Name): ALPHA REHAB CENTER, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 05/25/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 HARLEM AVE SUITE 3
BERWYN IL
60402-2996
US

IV. Provider business mailing address

3253 HARLEM AVE SUITE 3
BERWYN IL
60402-2996
US

V. Phone/Fax

Practice location:
  • Phone: 708-317-5553
  • Fax: 708-788-4757
Mailing address:
  • Phone: 708-317-5553
  • Fax: 708-788-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038010321
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038010456
License Number StateIL

VIII. Authorized Official

Name: DR. ASHISH SUD
Title or Position: PRESIDENT
Credential: DC
Phone: 708-317-5553