Healthcare Provider Details

I. General information

NPI: 1306915095
Provider Name (Legal Business Name): THE REHABILITATION INSTITUTE OF CHICAO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N CLARK ST SUITE 647
CHICAGO IL
60610-5467
US

IV. Provider business mailing address

1030 N CLARK ST SUITE 647
CHICAGO IL
60610-5467
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-7891
  • Fax: 312-238-7881
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. AMIE L. KING
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 312-238-7891