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NPI Code Detail

MEDICARE: VITAL REHABILITATION ASSOCIATION, INC.

MEDICARE: VITAL REHABILITATION ASSOCIATION, INC.
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
1261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1407858483
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITAL REHABILITATION ASSOCIATION, INC.
Provider Business Mailing Address
First Line : 5820 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2616
Country : US
Telephone Number : 773-685-8482
Fax Number : 773-685-8479
Provider Business Practice Location Address
First Line : 5820 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2616
Country : US
Telephone Number : 773-685-8482
Fax Number : 773-685-8479
Authorized Official
Title or Position : OWNER/PRESIDENT/HEAD THERAPIST
Name : MR. TOMASZ J KOKOCINSKI
Credential : LICENSED PHYSICAL TH
Telephone Number : 773-685-8482
Provider Enumeration Date : 08/10/2005
Last Update Date : 11/02/2011

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