MEDICARE: IMMANUEL PHYSICAL REHABILITATION INSTITUTE 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	225100000X	Physical Therapist	070013396	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699922583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMANUEL PHYSICAL REHABILITATION INSTITUTE PC

Provider Business Mailing Address
First Line	:	15 E GOLF RD STE B
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4014
Country	:	US
Telephone Number	:	847-734-9303
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 E GOLF RD STE B
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4014
Country	:	US
Telephone Number	:	847-734-9303
Fax Number	:

Authorized Official
Title or Position	:	P.T.
Name	:	CHANG-JUN YU
Credential	:
Telephone Number	:	847-734-9303

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/26/2008

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