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NPI Code Detail

MEDICARE: PROREHAB, PC

MEDICARE: PROREHAB, 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
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1861594160
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROREHAB, PC
Provider Business Mailing Address
First Line : 625 ENTERPRISE DR
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8813
Country : US
Telephone Number : 630-575-6200
Fax Number :
Provider Business Practice Location Address
First Line : 951 WATERBURY FALLS DR
Second Line :
City : O FALLON
State : MO
Zip : 63368-2202
Country : US
Telephone Number : 636-336-0300
Fax Number : 636-336-0297
Authorized Official
Title or Position : DIRECTOR OF CLINICAL SERVICES
Name : GERI COOK
Credential :
Telephone Number : 630-575-1940
Provider Enumeration Date : 09/05/2006
Last Update Date : 07/11/2016

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