Organization
INDIVIDUAL REHAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY MITCHEL (PRESIDENT)
(312) 440-1122
Entity
Organization
Contact information
Practice address
806 CENTRAL AVE, HIGHLAND PARK, IL 60035-5613
(312) 440-1122
(312) 440-1177
Mailing address
PO BOX 641043, CHICAGO, IL 60664-1043
(312) 440-1122
(312) 440-1144
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01622729
BCBS
IL
Enumeration date
12/15/2006
Last updated
08/22/2020
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