Healthcare Provider Details

I. General information

NPI: 1871661827
Provider Name (Legal Business Name): FLEXEON REHABILITATION - CLINTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N CLINTON ST SUITE 2 SOUTH
CHICAGO IL
60661-1282
US

IV. Provider business mailing address

211 N CLINTON ST SUITE 2 SOUTH
CHICAGO IL
60661-1282
US

V. Phone/Fax

Practice location:
  • Phone: 312-268-6050
  • Fax: 312-258-0335
Mailing address:
  • Phone: 312-268-6050
  • Fax: 312-258-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES D JUDGE
Title or Position: PARTNER
Credential: PT
Phone: 219-922-9508