Healthcare Provider Details

I. General information

NPI: 1922051507
Provider Name (Legal Business Name): PROREHAB PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 N OUTER 40 RD SUITE 300
CHESTERFIELD MO
63017-2152
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 636-812-1211
  • Fax: 636-812-0159
Mailing address:
  • Phone: 630-575-1980
  • 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: GERI COOK
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential:
Phone: 630-575-1940