=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376715433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABILITATION SERVICES GROUP LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2008
-----------------------------------------------------
Last Update Date | 03/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6039 W BELMONT AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60634-5116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-254-3621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6039 W BELMONT AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60634-5116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-254-3621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PT
-----------------------------------------------------
Name | DR. LECH BLACHURA
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 630-254-3621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------