Organization
JACOB'S LADDER PEDIATRIC REHAB CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY HALL (DIRECTOR OF ADMIN OPERATIONS)
(219) 250-3203
Entity
Organization
Contact information
Practice address
1595 S CALUMET RD STE 3, CHESTERTON, IN 46304-2389
(219) 763-6858
(219) 763-4858
Mailing address
1595 S CALUMET RD STE 3, CHESTERTON, IN 46304-2389
(219) 764-4888
(219) 764-4805
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200196020A
—
IN
Enumeration date
10/31/2006
Last updated
03/04/2025
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