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General NPI Number Information
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NPI Number | 1215731575
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Entity Type | Organization
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Legal Business Name | MELROSE PARK REHABILITATION, LTD
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 1440 W NORTH AVE STE 310
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City | MELROSE PARK
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State | IL
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Zip | 60160-1426
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Country | US
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Telephone | 708-627-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 W NORTH AVE STE 310
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City | MELROSE PARK
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State | IL
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Zip | 60160-1426
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Country | US
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Telephone | 708-627-3057
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | STEFANIE SHAW
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Credential |
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Telephone | 708-627-3057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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