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General NPI Number Information
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NPI Number | 1376603522
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Entity Type | Organization
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Legal Business Name | REHABEDGE, LLC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 127 N MAIN ST
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City | HILLSBORO
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State | IL
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Zip | 62049
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Country | US
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Telephone | 217-532-3330
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Fax | 217-532-5149
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Provider Business Mailing Address
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Address Line | 127 N MAIN ST
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City | HILLSBORO
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State | IL
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Zip | 62049
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Country | US
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Telephone | 217-532-3330
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Fax | 217-532-5149
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Authorized Official
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Title or Position | OWNER
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Name | JOHN MEKALA
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Credential | PT
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Telephone | 217-532-3330
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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 | 070008303
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License Number State | IL
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