MEDICARE: PROREHAB PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1003354218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROREHAB PC

Provider Business Mailing Address
First Line	:	625 ENTERPRISE DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-8813
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 WINDING WOODS CTR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-4170
Country	:	US
Telephone Number	:	636-439-2004
Fax Number	:	636-439-2054

Authorized Official
Title or Position	:	VP OF BILLING OPERATIONS
Name	:	GERI COOK
Credential	:
Telephone Number	:	630-575-1980

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	02/08/2017

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Directions to “PROREHAB PC ” Practice Location

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