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General NPI Number Information
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NPI Number | 1740236512
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Entity Type | Organization
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Legal Business Name | PROREHAB, PC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 5300 N ILLINOIS ST SUITE 101
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-3500
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Country | US
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Telephone | 618-624-9300
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Fax | 618-624-9330
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Provider Business Mailing Address
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Address Line | 625 ENTERPRISE DR
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City | OAK BROOK
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State | IL
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Zip | 60523-8813
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Country | US
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Telephone | 630-575-6200
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | GERI COOK
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Credential |
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Telephone | 630-575-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | IL
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