Organization
PROREHAB PC
Active
Other names
ATHLETICO PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
JUANA GRANADOS (CREDENTIALING MANAGER)
(630) 575-1980
Entity
Organization
Contact information
Practice address
709 W. MARION STREET, MARION, IL 62959-2439
(618) 579-0953
(618) 551-1088
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/18/2018
Last updated
05/18/2018
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