# PRARIE STATE REHABILITATION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770050668
- **Authorized official:** JASON DOUGLAS FREEMAN DO (OWNER)
- **Authorized official phone:** (708) 275-4087

## Contact information

- **Practice address:** 12220 S CHEYENNE DR, PALOS HEIGHTS, IL 60463-1654
- **Practice address phone:** (708) 275-4087
- **Mailing address:** 12220 S CHEYENNE DR, PALOS HEIGHTS, IL 60463-1654
- **Mailing address phone:** (708) 275-4087

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/29/2018
- **Last updated:** 10/29/2018