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General NPI Number Information
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NPI Number | 1942584214
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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 | 10/05/2011
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Last Update Date | 11/23/2018
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Provider Practice Location Address
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Address Line | 1837 HOMER M ADAMS PKWY SUITE M
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City | ALTON
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State | IL
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Zip | 62002-5665
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Country | US
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Telephone | 618-208-3310
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Fax | 618-208-3315
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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 | 630-928-5080
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JUANA GRANADOS
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Credential |
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Telephone | 630-575-1980
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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 |
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