Provider Demographics
NPI:1003842261
Name:COLUMBIA REHAB SPECIALISTS, LLC
Entity Type:Organization
Organization Name:COLUMBIA REHAB SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BADGEROW-WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OCS
Authorized Official - Phone:618-281-0374
Mailing Address - Street 1:236 SOUTHWOODS CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2462
Mailing Address - Country:US
Mailing Address - Phone:618-281-0374
Mailing Address - Fax:618-281-0674
Practice Address - Street 1:236 SOUTHWOODS CTR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2462
Practice Address - Country:US
Practice Address - Phone:618-281-0374
Practice Address - Fax:618-281-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
277645OtherGHP
5660579OtherFIRST HEALTH/CCN
9419162OtherPHCS
13897OtherESSENCE HEALTHCARE
205903OtherBC/BS OF MO
7361646OtherAETNA
K23120OtherMERCY
IL355645409001Medicaid
06732025OtherBC/BS OF IL
737359OtherHEALTHLINK
5660579OtherFIRST HEALTH/CCN
=========OtherUHC