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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1134172323
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	:	630-575-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 PROGRESS PKWY
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-2359
Country	:	US
Telephone Number	:	573-860-5901
Fax Number	:	573-860-5903

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	GERI COOK
Credential	:
Telephone Number	:	630-575-1940

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/07/2016

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