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General NPI Number Information
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NPI Number | 1386321404
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Entity Type | Organization
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Legal Business Name | PROTOCOL 1 REHAB, LLC
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 524 W 5TH AVE
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City | NAPERVILLE
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State | IL
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Zip | 60563-2901
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Country | US
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Telephone | 630-362-6055
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Fax |
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Provider Business Mailing Address
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Address Line | 524 W 5TH AVE
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City | NAPERVILLE
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State | IL
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Zip | 60563-2901
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Country | US
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Telephone | 630-362-6055
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM BOLSTER
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Credential | DC
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Telephone | 630-362-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical 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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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