Healthcare Provider Details

I. General information

NPI: 1023023579
Provider Name (Legal Business Name): REHAB INNOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N EMERALD LN SUITE 1A
CARBONDALE IL
62901-2100
US

IV. Provider business mailing address

PO BOX 55
CARBONDALE IL
62903-0055
US

V. Phone/Fax

Practice location:
  • Phone: 618-549-9449
  • Fax:
Mailing address:
  • Phone: 618-549-9449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DON L HOWARD
Title or Position: ADMINISTRATOR
Credential: MS, ATC, PTA
Phone: 618-549-9449