Healthcare Provider Details

I. General information

NPI: 1144450743
Provider Name (Legal Business Name): KENNETIC REHAB SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 CURTISS ST STE 4
DOWNERS GROVE IL
60515-4660
US

IV. Provider business mailing address

5801 BLACKSTONE AVE
LA GRANGE HIGHLANDS IL
60525-7108
US

V. Phone/Fax

Practice location:
  • Phone: 630-964-4008
  • Fax: 773-767-3944
Mailing address:
  • Phone: 630-964-4008
  • Fax: 773-767-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

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