Provider Demographics
NPI:1346538196
Name:SPECKMAN REHAB CENTER OSWEGO INC.
Entity Type:Organization
Organization Name:SPECKMAN REHAB CENTER OSWEGO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SPECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-553-6888
Mailing Address - Street 1:26 W VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7211
Mailing Address - Country:US
Mailing Address - Phone:630-553-6888
Mailing Address - Fax:
Practice Address - Street 1:26 W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7211
Practice Address - Country:US
Practice Address - Phone:630-553-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty