Provider Demographics
NPI:1316029275
Name:EXTRAORDINARY REHAB SERVICES, LLC
Entity Type:Organization
Organization Name:EXTRAORDINARY REHAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MHS
Authorized Official - Phone:219-308-2265
Mailing Address - Street 1:325 GLASTONBURY ST
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-9124
Mailing Address - Country:US
Mailing Address - Phone:219-308-2265
Mailing Address - Fax:219-934-9102
Practice Address - Street 1:325 GLASTONBURY ST
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-9124
Practice Address - Country:US
Practice Address - Phone:219-308-2265
Practice Address - Fax:219-934-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003716A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty