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Organization
SBPT INC
Active
Organization
SBPT INC
Active
Other names
Park Ridge Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN J WALLNER (PRESIDENT)
(847) 768-9240
Entity
Organization
Contact information
Practice address
1480 RENAISSANCE DRIVE, STE 304, PARK RIDGE, IL 60068
(847) 768-9240
(847) 768-9304
Mailing address
1480 RENAISSANCE DRIVE, STE 304, PARK RIDGE, IL 60068
(847) 768-9240
(847) 768-9304
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322924361001
—
IL
Enumeration date
10/20/2006
Last updated
08/22/2020
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