Provider Demographics
NPI:1114086543
Name:DUPAGE REHABILITATION, INC.
Entity Type:Organization
Organization Name:DUPAGE REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EARL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-848-1744
Mailing Address - Street 1:10 W MARTIN AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6590
Mailing Address - Country:US
Mailing Address - Phone:630-848-1744
Mailing Address - Fax:630-848-1745
Practice Address - Street 1:10 W MARTIN AVE STE 226
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6590
Practice Address - Country:US
Practice Address - Phone:630-848-1744
Practice Address - Fax:630-848-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-11-01
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
IL80314OtherUNICARE
IL2232697OtherBLUE CROSS
IL9302077OtherPHCS
IL696792OtherUNITED HEALTHCARE
IL213220Medicare PIN