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General NPI Number Information
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NPI Number | 1235514241
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Entity Type | Organization
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Legal Business Name | ACCELERATED REHABILITATION CENTER OF KENOSHA LTD
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 6502 JOLIET RD
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-4682
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Country | US
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Telephone | 708-352-0547
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Fax | 708-352-1535
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Provider Business Mailing Address
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Address Line | 2998 MOMENTUM PL
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City | CHICAGO
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State | IL
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Zip | 60689-5330
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Country | US
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Telephone | 262-657-0222
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Fax | 262-657-7190
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Authorized Official
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Title or Position | UPFRONT SYSTEM DIRECTOR
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Name | TASYA EXNER
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Credential |
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Telephone | 262-657-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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