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General NPI Number Information
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NPI Number | 1093188062
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Entity Type | Organization
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Legal Business Name | SELECT REHABILITATION INC
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 720 ARBOR VITAE PL
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City | VERONA
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State | WI
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Zip | 53593-1763
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Country | US
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Telephone | 847-441-5593
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 COMPASS RD
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City | GLENVIEW
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State | IL
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Zip | 60026-8001
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Country | US
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Telephone | 847-441-5593
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ANNA GARDINA WOLFE
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Credential |
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Telephone | 847-441-5593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 2133-26
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License Number State | WI
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