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General NPI Number Information
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NPI Number | 1811176894
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Entity Type | Organization
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Legal Business Name | PRO SPORTS & SPINE REHABILITATION, SC
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 6374 N LINCOLN AVE SUITE 301
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City | CHICAGO
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State | IL
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Zip | 60659-1275
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Country | US
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Telephone | 630-924-1450
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Fax | 630-924-1459
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Provider Business Mailing Address
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Address Line | 6374 N LINCOLN AVE SUITE 301
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City | CHICAGO
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State | IL
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Zip | 60659-1275
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Country | US
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Telephone | 630-924-1450
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Fax | 630-924-1459
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Authorized Official
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Title or Position | OFFICER
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Name | DR. JOHN C SARANTOPOULOS
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Credential | DO
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Telephone | 630-924-1450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036094371
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License Number State | IL
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