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General NPI Number Information
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NPI Number | 1518523307
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Entity Type | Organization
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Legal Business Name | NORTH LAKE THERAPY & REHAB INC
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 213 N LAKE ST
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City | AURORA
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State | IL
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Zip | 60506-4682
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Country | US
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Telephone | 708-425-3135
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 578220
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City | CHICAGO
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State | IL
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Zip | 60657-7303
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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 | OWNER
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Name | SAOUD DABBAH
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Credential | DC
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Telephone | 847-219-2723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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