Healthcare Provider Details

I. General information

NPI: 1548032980
Provider Name (Legal Business Name): REPRIME REHAB AND PERFORMANCE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 REHBEHN CT
YORKVILLE IL
60560-2435
US

IV. Provider business mailing address

3122 REHBEHN CT
YORKVILLE IL
60560-2435
US

V. Phone/Fax

Practice location:
  • Phone: 847-421-4269
  • Fax:
Mailing address:
  • Phone: 847-421-4269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIK BOILESEN
Title or Position: OWNER
Credential: DPT
Phone: 847-421-4269