Healthcare Provider Details

I. General information

NPI: 1609940162
Provider Name (Legal Business Name): THER-A-CARE REHABILITATION LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E WILLOW ST STE A
COAL CITY IL
60416-1868
US

IV. Provider business mailing address

35 E WILLOW ST STE A
COAL CITY IL
60416-1868
US

V. Phone/Fax

Practice location:
  • Phone: 815-634-3550
  • Fax:
Mailing address:
  • Phone: 815-634-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070011646
License Number StateIL

VIII. Authorized Official

Name: WANDA J NEE
Title or Position: OWNER
Credential: PT
Phone: 815-634-3550