MEDICARE: ORTHO REHABILITATION CENTER, 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
1	225100000X	Physical Therapist	070007313	IL

General Provider Information

NPI Number	:	1902073760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO REHABILITATION CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 5979
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-5979
Country	:	US
Telephone Number	:	847-897-5995
Fax Number	:	847-897-5990

Provider Business Practice Location Address
First Line	:	6300 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1702
Country	:	US
Telephone Number	:	773-465-0040
Fax Number	:	773-465-0044

Authorized Official
Title or Position	:	OWNER
Name	:	SALIM A MAZHAR
Credential	:
Telephone Number	:	773-465-0040

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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