Healthcare Provider Details

I. General information

NPI: 1447401559
Provider Name (Legal Business Name): OPTIMUM HEALTH & REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 04/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 GOLF RD STE 204
DES PLAINES IL
60016-1687
US

IV. Provider business mailing address

9301 GOLF RD STE 204
DES PLAINES IL
60016-1687
US

V. Phone/Fax

Practice location:
  • Phone: 847-391-9720
  • Fax: 773-767-3944
Mailing address:
  • Phone: 847-391-9720
  • Fax: 773-767-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070011869
License Number StateIL

VIII. Authorized Official

Name: LYNNETTE R MCROY
Title or Position: BILLLING COORDINATOR
Credential:
Phone: 773-767-3822