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Organization
PROREHAB PC
Active
Organization
PROREHAB PC
Active
Parent organization
PROREHAB PC
Other names
ATHLETICO PHYSICAL THERAPY
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROREHAB PC
Authorized official
JUANA GRANADOS (CREDENTIALING MANANGER)
(630) 575-1980
Entity
Organization
Contact information
Practice address
603 S BISHOP AVE STE B, ROLLA, MO 65401-4320
(573) 202-6537
(573) 426-7001
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6250
(630) 575-7450
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Enumeration date
05/26/2020
Last updated
05/26/2020
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