MEDICARE: THE REHABILITATION INSTITUTE OF CHICAO

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	261QP3300X	Pain Clinic/Center		IL

General Provider Information

NPI Number	:	1306915095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE REHABILITATION INSTITUTE OF CHICAO

Provider Business Mailing Address
First Line	:	1030 N CLARK ST
Second Line	:	SUITE 647
City	:	CHICAGO
State	:	IL
Zip	:	60610-5467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 N CLARK ST
Second Line	:	SUITE 647
City	:	CHICAGO
State	:	IL
Zip	:	60610-5467
Country	:	US
Telephone Number	:	312-238-7891
Fax Number	:	312-238-7881

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MRS. AMIE L. KING
Credential	:	PT
Telephone Number	:	312-238-7891

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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