MEDICARE: PROFESSIONAL SPORTSCARE & REHAB, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist
3	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1033142294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL SPORTSCARE & REHAB, LLC

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	252-248-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 S PLEASANT VALLEY RD
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6518
Country	:	US
Telephone Number	:	540-228-1941
Fax Number	:

Authorized Official
Title or Position	:	DIRECTORY, CREDENTIALING
Name	:	JUANA GRANADOS
Credential	:
Telephone Number	:	630-575-1980

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/06/2026

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