MEDICARE: MELROSE PARK REHABILITATION, LTD

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	111N00000X	Chiropractor
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1215731575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELROSE PARK REHABILITATION, LTD

Provider Business Mailing Address
First Line	:	1440 W NORTH AVE STE 310
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1426
Country	:	US
Telephone Number	:	708-627-3057
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 W NORTH AVE STE 310
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1426
Country	:	US
Telephone Number	:	708-627-3057
Fax Number	:

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	STEFANIE SHAW
Credential	:
Telephone Number	:	708-627-3057

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	04/03/2025

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