Healthcare Provider Details

I. General information

NPI: 1376780205
Provider Name (Legal Business Name): FULLERTON REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 W FULLERTON AVE
CHICAGO IL
60639-2503
US

IV. Provider business mailing address

6445 N CENTRAL AVE
CHICAGO IL
60646-2901
US

V. Phone/Fax

Practice location:
  • Phone: 773-237-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.005171
License Number StateIL

VIII. Authorized Official

Name: MARGARET M NAULTY
Title or Position: PT
Credential:
Phone: 773-594-0225