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General NPI Number Information
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NPI Number | 1679635338
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL REHAB, INC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 806 CENTRAL AVE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5613
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Country | US
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Telephone | 312-440-1122
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Fax | 312-440-1177
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Provider Business Mailing Address
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Address Line | PO BOX 641043
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City | CHICAGO
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State | IL
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Zip | 60664-1043
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Country | US
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Telephone | 312-440-1122
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Fax | 312-440-1144
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARRY MITCHEL
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Credential |
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Telephone | 312-440-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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