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 MANAGER)
(630) 575-1980
Entity
Organization
Contact information
Practice address
3156 TELEGRAPH RD, SAINT LOUIS, MO 63125-5500
(314) 894-8616
(314) 894-8633
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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