Organization
PRACTICAL REHAB SERVICES, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHARON K JOHNSON PHD (PRESIDENT)
(618) 465-6566
Entity
Organization
Contact information
Practice address
3550 COLLEGE AVE, SUITE A, ALTON, IL 62002-5008
(618) 465-6566
(618) 465-6573
Mailing address
3550 COLLEGE AVE, SUITE A, ALTON, IL 62002-5008
(618) 465-6566
(618) 465-6573
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
327366709001
—
IL
05
—
348589310001
—
IL
Enumeration date
11/17/2005
Last updated
08/22/2020
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