Provider Demographics
NPI:1316009061
Name:INDIVIDUAL REHAB INC
Entity Type:Organization
Organization Name:INDIVIDUAL REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-440-1122
Mailing Address - Street 1:PO BOX 641043
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60664-1043
Mailing Address - Country:US
Mailing Address - Phone:312-440-1122
Mailing Address - Fax:312-440-1177
Practice Address - Street 1:401 W ONTARIO ST STE 240
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6957
Practice Address - Country:US
Practice Address - Phone:312-440-1122
Practice Address - Fax:312-440-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622729OtherBCBS
IL200944Medicare ID - Type UnspecifiedMEDICARE CHICAGO