MEDICARE: REBOOT THERAPY PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1437084639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBOOT THERAPY PLLC

Provider Business Mailing Address
First Line	:	917 W 18TH ST STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 W 18TH ST STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2400
Country	:	US
Telephone Number	:	872-297-0222
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KELLIE SOLLIDAY
Credential	:
Telephone Number	:	872-297-0222

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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