Healthcare Provider Details

I. General information

NPI: 1205232147
Provider Name (Legal Business Name): TEAM REHABILITATION IL02 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 PLAINFIELD RD SUITE C
WILLOWBROOK IL
60527-7607
US

IV. Provider business mailing address

33900 HARPER AVE SUITE 104
CLINTON TOWNSHIP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 630-282-6555
  • Fax: 630-986-7505
Mailing address:
  • Phone: 586-416-9100
  • Fax: 586-416-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES ROONEY
Title or Position: CEO
Credential:
Phone: 586-416-9100