Provider Demographics
NPI:1013194851
Name:3M REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:3M REHABILITATION SERVICES INC
Other - Org Name:MARK KUKLEWICZ LPT
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-399-1150
Mailing Address - Street 1:7961 W COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3533
Mailing Address - Country:US
Mailing Address - Phone:708-453-5112
Mailing Address - Fax:705-453-5120
Practice Address - Street 1:7961 W COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-3533
Practice Address - Country:US
Practice Address - Phone:708-453-5112
Practice Address - Fax:705-453-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
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
IL01620328OtherBCBS
IL347980Medicare PIN