Healthcare Provider Details

I. General information

NPI: 1639554553
Provider Name (Legal Business Name): ACCELERATED REHABILITATION CENTER OF KENOSHA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S STATE ST
MARENGO IL
60152-3532
US

IV. Provider business mailing address

2998 MOMENTUM PL
CHICAGO IL
60689-5330
US

V. Phone/Fax

Practice location:
  • Phone: 815-568-4550
  • Fax: 815-568-5071
Mailing address:
  • Phone: 262-657-0222
  • Fax: 262-657-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TASYA EXNER
Title or Position: UPFRONT SYSTEM DIRECTOR
Credential:
Phone: 262-657-0222