Organization
TRICARE REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL BROGDON (VICE PRESIDENT OF OPERATIONS)
(219) 898-3422
Entity
Organization
Contact information
Practice address
150 FENCL LN, HILLSIDE, IL 60162-2041
(812) 432-3610
Mailing address
12803 LENOVER ST., DILLSBORO, IN 47018
(812) 432-3610
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
99048396A
IN
Other
Enumeration date
11/19/2011
Last updated
11/19/2011
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