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Organization
COVENANT ALLIANCE REHAB
Active
Organization
COVENANT ALLIANCE REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN CALLEN (PRESIDENT)
(630) 413-5820
Entity
Organization
Contact information
Practice address
1520 KENSINGTON RD, SUITE 110, OAK BROOK, IL 60523-2139
(630) 413-5800
(630) 413-5801
Mailing address
1520 KENSINGTON RD, SUITE 110, OAK BROOK, IL 60523-2139
(630) 413-5800
(630) 413-5801
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
2279G0305X
Geriatric Care Registered Respiratory Therapist
—
NULL
2279G0305X
Geriatric Care Registered Respiratory Therapist
—
—
231H00000X
Audiologist
—
NULL
231H00000X
Audiologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10414859
STATE LICENSE NUMBER
AZ
Enumeration date
01/21/2014
Last updated
01/21/2014
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