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General NPI Number Information
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NPI Number | 1326150624
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Entity Type | Organization
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Legal Business Name | SPORTS PHYSICAL THERAPY & REHAB SPECIALISTS, S.C.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 3915 30TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-1957
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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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Provider Business Mailing Address
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Address Line | 625 ENTERPRISE DR
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City | OAK BROOK
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State | IL
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Zip | 60523-8813
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Country | US
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Telephone | 630-575-1980
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Fax | 630-928-5080
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MR. JUANA L FERNANDEZ
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Credential |
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Telephone | 630-575-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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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