Provider Demographics
NPI:1063469906
Name:PRO-HEALTH PHYSICAL REHABILITATION SERVICES P C
Entity Type:Organization
Organization Name:PRO-HEALTH PHYSICAL REHABILITATION SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:O
Authorized Official - Last Name:AROWOLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-312-8022
Mailing Address - Street 1:235 REMINGTON BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5826
Mailing Address - Country:US
Mailing Address - Phone:630-312-8022
Mailing Address - Fax:630-312-8660
Practice Address - Street 1:235 REMINGTON BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5826
Practice Address - Country:US
Practice Address - Phone:630-312-8022
Practice Address - Fax:630-312-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932380OtherBCBSIL PROVIDER NO
ILY29392Medicare UPIN
IL211139Medicare UPIN