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Organization
REVIVAL REHAB PC
Active
Organization
REVIVAL REHAB PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEDHAT BADR (PRESIDENT)
(708) 323-7608
Entity
Organization
Contact information
Practice address
1701 CATON RIDGE DR, PLAINFIELD, IL 60544-5635
(708) 323-7608
(708) 286-6461
Mailing address
1701 CATON RIDGE DR, PLAINFIELD, IL 60544-5635
(708) 323-7608
(708) 286-6461
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070006996
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070006996
STATE OF IL 070006996
IL
Enumeration date
10/07/2010
Last updated
10/07/2010
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