Healthcare Provider Details

I. General information

NPI: 1265519151
Provider Name (Legal Business Name): JACOB'S LADDER PEDIATRIC REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 S CALUMET RD STE 3
CHESTERTON IN
46304-2389
US

IV. Provider business mailing address

1595 S CALUMET RD STE 3
CHESTERTON IN
46304-2389
US

V. Phone/Fax

Practice location:
  • Phone: 219-763-6858
  • Fax: 219-763-4858
Mailing address:
  • Phone: 219-764-4888
  • Fax: 219-764-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACY HALL
Title or Position: DIRECTOR OF ADMIN OPERATIONS
Credential:
Phone: 219-250-3203