Healthcare Provider Details

I. General information

NPI: 1881963288
Provider Name (Legal Business Name): ELITE REHABILITATION INSTITUTE, PHYSICAL THERAPY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13520 SOUTH RTE. 59 SUITE 106
PLAINFIELD IL
60544
US

IV. Provider business mailing address

28 N CASS AVE
WESTMONT IL
60559-1602
US

V. Phone/Fax

Practice location:
  • Phone: 815-254-1159
  • Fax: 815-254-1159
Mailing address:
  • Phone: 630-615-9170
  • Fax: 630-493-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070013955
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FRANK MARTIN PUC
Title or Position: PRESIDENT
Credential: PT
Phone: 630-615-9170