Provider Demographics
NPI:1164011235
Name:BTD REHAB LLC
Entity Type:Organization
Organization Name:BTD REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-271-6872
Mailing Address - Street 1:301 WEST GRAND AVE
Mailing Address - Street 2:SUITE 367
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4640
Mailing Address - Country:US
Mailing Address - Phone:773-585-5900
Mailing Address - Fax:773-904-4302
Practice Address - Street 1:1011 ESSINGTON ROAD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2869
Practice Address - Country:US
Practice Address - Phone:773-585-5900
Practice Address - Fax:773-904-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty