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General NPI Number Information
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NPI Number | 1356430425
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL REHABILITATION GROUP
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 41 E MAIN ST
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City | LAKE ZURICH
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State | IL
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Zip | 60047-3413
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Country | US
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Telephone | 847-877-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 44 PARK VIEW LN
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City | HAWTHORN WOODS
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State | IL
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Zip | 60047-8972
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BEATA REDLICKI
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Credential |
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Telephone | 847-877-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | IL
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