Healthcare Provider Details

I. General information

NPI: 1477566081
Provider Name (Legal Business Name): CENTER FOR ORTHOPEDIC AND REHABILITATION EXCELLENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 W MADISON ST SUITE 103
CHICAGO IL
60607-2638
US

IV. Provider business mailing address

PO BOX 3497
STURTEVANT WI
53177-3497
US

V. Phone/Fax

Practice location:
  • Phone: 866-868-0764
  • Fax: 312-492-7953
Mailing address:
  • Phone: 877-552-2996
  • Fax: 866-245-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY D BRIAND
Title or Position: CO-OWNER
Credential: MS, PT, ATC
Phone: 877-552-2996