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General NPI Number Information
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NPI Number | 1518127539
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Entity Type | Organization
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Legal Business Name | INFINITY REHAB
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 208 E 9TH ST APT A
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City | STERLING
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State | IL
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Zip | 61081-2444
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Country | US
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Telephone | 815-499-1269
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Fax |
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Provider Business Mailing Address
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Address Line | 208 E 9TH ST APT A
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City | STERLING
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State | IL
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Zip | 61081-2444
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Country | US
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Telephone | 815-499-1269
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | MISS JESSICA RAE LOVE
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Credential | PTA
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Telephone | 815-499-1269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1484895
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License Number State | IL
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