MEDICARE: COMMUNITY REHAB LLC

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

General Provider Information

NPI Number	:	1932218773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY REHAB LLC

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2222
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	2601 CORNHUSKER DR STE 11
Second Line	:
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3919
Country	:	US
Telephone Number	:	402-370-9651
Fax Number	:

Authorized Official
Title or Position	:	VP CHIEF COMPLIANCE OFFICER
Name	:	WADE MEYER
Credential	:
Telephone Number	:	630-296-2222

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	01/26/2024

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