Healthcare Provider Details

I. General information

NPI: 1194898114
Provider Name (Legal Business Name): VITAL REHABILITATION & PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 S KEDZIE
MERRIONETTE PARK IL
60803
US

IV. Provider business mailing address

5820 W IRVING PARK RD
CHICAGO IL
60634
US

V. Phone/Fax

Practice location:
  • Phone: 708-371-6441
  • Fax: 708-371-6429
Mailing address:
  • Phone: 773-685-8482
  • Fax: 773-685-8479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MR. TOMASZ J KOKOCINSKI
Title or Position: PRESIDENT
Credential: DPT
Phone: 708-371-6441