Organization
WORKSPORT REHABILITATION SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL BROOKS RPT (PRESIDENT/OWNER)
(219) 325-0060
Entity
Organization
Contact information
Practice address
2338 N US HIGHWAY 35, LA PORTE, IN 46350-8380
(219) 325-0060
(219) 325-9919
Mailing address
2338 N US HIGHWAY 35, LA PORTE, IN 46350-8380
(219) 325-0060
(219) 325-9919
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
05002570A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000093552
BC BS PROVIDER NUMBER
IN
05
—
200240530A
—
IN
05
—
200891110B
—
IN
Enumeration date
09/26/2006
Last updated
10/18/2010
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