Healthcare Provider Details

I. General information

NPI: 1720010168
Provider Name (Legal Business Name): PRO-REHAB SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 W COLLEGE DR SUITE 800
PALOS HEIGHTS IL
60463-1785
US

IV. Provider business mailing address

6400 W COLLEGE DR SUITE 800
PALOS HEIGHTS IL
60463-1785
US

V. Phone/Fax

Practice location:
  • Phone: 708-489-6777
  • Fax: 708-489-6303
Mailing address:
  • Phone: 708-489-6777
  • Fax: 708-489-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateIL

VIII. Authorized Official

Name: JACOB MUTHOLAM
Title or Position: PRESIDENT/ADMINISTRATOR
Credential: PT
Phone: 708-489-6777