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General NPI Number Information
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NPI Number | 1922414028
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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 | 07/09/2014
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 8023 W FLORISSANT AVE STE A
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City | JENNINGS
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State | MO
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Zip | 63136-1448
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Country | US
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Telephone | 314-833-1000
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Fax | 314-833-1001
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Provider Business Mailing Address
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Address Line | 600 OAKMONT LN STE 600C
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City | WESTMONT
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State | IL
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Zip | 60559-5548
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Country | US
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Telephone | 630-575-1980
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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 | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | C1618
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License Number State | MO
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