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General NPI Number Information
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NPI Number | 1639221682
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Entity Type | Organization
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Legal Business Name | PEDIATRIC REHABILITATION SERVICES
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5201 WALNUT AVENUE STE 4
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-4025
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Country | US
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Telephone | 630-964-4707
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Fax | 630-964-4797
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Provider Business Mailing Address
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Address Line | 5201 WALNUT AVENUE STE 4
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-4025
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Country | US
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Telephone | 630-964-4707
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Fax | 630-964-4797
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. ELIZABETH JOHNSON MARUVAMA
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Credential | OTRL
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Telephone | 630-964-4707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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